"People Will Talk about Her If She Is Not Circumcised": Exploring the Patterning, Drivers and Gender Norms around Female Genital Mutilation in Ethiopia's Somali Region

"The mother is insulted if a girl is not circumcised when she is married. We do not want to get insulted."

Social norms theory has long been used to explain the harmful practice of female genital mutilation (FGM), which affects around 200 million girls and women globally. In Ethiopia, rates of FGM are highest in the Somali region, where most households are pastoralists, education levels remain extremely low, and the regional government has yet to ratify the national law that prohibits FGM. Support for FGM in this region is not due to a poor understanding of the risks involved; however, these risks are perceived as less potent than the social risks of rejecting FGM (such as social exclusion) or the advantages of perpetuating it (ability to marry, for example). Drawing on mixed-methods research undertaken by the Gender and Adolescence: Global Evidence (GAGE) research programme, this article explores the patterning, drivers, and decision-making around FGM in Ethiopia's Somali region.

From 2022 to 2023, the researchers conducted private face-to-face surveys with 1,020 adolescents (aged 10 to 19) and their caregivers in 18 communities in three districts (Daror, Goljano and Harshen) of Somali regional state. Interviews - all of which were private - were also conducted with key informants, including: government officials at community to regional levels; educational, health, social development and justice service providers; and clan and religious leaders.

Of surveyed adolescent girls who acknowledged having heard of FGM and were willing to answer questions about it (N = 609), nearly three-quarters (72%) reported having undergone FGM. Findings indicate that almost all Somali girls can expect to undergo FGM before age 15 and that infibulation (the most severe form of the practice) is near universal. Respondents' understanding of infibulation is rooted in traditional practice, and many girls are now "partially" infibulated, an invasive procedure that girls nonetheless see as an improvement over the past. These shifts reflect religious leaders' efforts to eliminate traditional infibulation - and the health risks it entails - by promoting "less invasive" types of FGM as a requirement of Islam.

Although the surveys found that FGM is universally carried out by traditional cutters (or by parents who hire traditional cutters, as reported in the case of the caregiver survey), the qualitative research - which allowed more time for trust to develop, more flexibility in regard to probing, and more space for respondents to report on practices in the broader community - found evidence of emerging medicalisation. As mothers, who are the primary decision-makers, seek to reduce risks, an increasing number of girls are taken to health centres, where healthcare workers use clean blades and anaesthesia and can manage bleeding. "Shifts in type and medicalization of the practice speak to the malleability of social norms, and underscore how practices can be adapted as communities unwilling to abandon FGM work to balance new knowledge about its risks with traditional beliefs about its social and cultural benefits..."

The survey also asked caregivers and girls who had undergone FGM whether they believe that FGM should continue and whether they believe that FGM is required by religion. Approximately two-thirds of survey respondents - mothers, fathers, and girls - agreed with both statements. Adult and adolescent respondents agree that FGM is a deeply embedded social norm, but they distinguish between FGM as a perceived religious requirement and infibulation as a cultural requirement. For girls and women, the importance of FGM is framed around social acceptance, whereas boys and men focus on FGM as a requirement for marriage, as it allows families to control girls' sexuality.

The article concludes by reflecting on the implications of the findings for programming in high-prevalence contexts. For instance, the researchers note that interventions aimed at encouraging the abandonment of FGM have generally centred on marriageability, presupposed a tipping point, and then pursued multiple avenues to build up a core group of champions for FGM abandonment. In a context such as the Somali region, where, as this study has shown, FGM is tied to multiple and intersecting norms- only one of which is marriageability - this research suggests that alternative strategies will be required.

The researchers recommend:

• Beginning with interventions aimed at girls and women and focused on gender norms - Such an approach is key in a context such as the Somali region, where women dominate decision-making on FGM. Programming, which for girls might be delivered through school- or community-based girls' clubs, could address: how gender norms advantage boys and men over girls and women (including beliefs about female hyper-sexuality and girls' devaluation in the event of rape); how girls and women help prevent those norms from shifting (including through ostracising females who are non-infibulated and rejecting the input of fathers); and what benefits FGM is perceived to provide (rather than focusing solely on its risks). Because older women - and especially traditional cutters - are accorded high respect among women, and because there is evidence that mothers are ignoring religious leaders' counsel regarding the type of FGM their daughter undergoes, it may be prudent to work with traditional cutters to develop and deliver programming.
• Engaging with boys and men - In this sample, fathers emerged as more likely advocates for the abandonment of traditional infibulation, apparently because of their greater exposure and buy-in to religious leaders' messaging. And although they appear to have limited ability to influence the type of FGM their daughters undergo, they may have more scope to influence their sons' preferences for infibulated wives.
• Conducting advocacy and outreach - Community-level efforts can be supported through continued engagement with the Somali regional government to ratify the Family Law and on the Regional Sharia Council to adopt the fatwa towards zero tolerance of FGM. They should also be supported by continued and stepped-up awareness-raising and education for concerned government sectors to ensure that human and financial resources are sustainably allocated to eliminating FGM. Outreach to healthcare workers and teachers is also needed to prevent medicalisation from becoming entrenched and to ensure that girls are being taught their rights at school, including the right to bodily integrity.
• Investing in context-tailored and evidence-informed programmatic responses that address emerging trends rather than adhering to accepted orthodox approaches - Although the eventual elimination of FGM is critical from a human rights perspective, in contexts where severe forms of the practice are widespread, it may be wise to defer the zero-tolerance policy - working first to eliminate traditional infibulation practices and then to eliminate FGM. The evident success of religious leaders in encouraging "partial" infibulation suggests that there is a potential programming entry point to advocate for further incremental change.