Decision-making in the practice of female genital mutilation or cutting in Sudan: a cross-sectional study

BACKGROUND: Female genital mutilation or cutting (FGM/C) is a form of violence against women and girls that is widely performed in about 30 countries in Africa, Middle East and Asia. In Sudan, the prevalence of FGM/C among women aged 15–49 years was 87% in 2014. Little is known about household decision-making as it relates to FGM/C. This study aimed to understand the key people involved in FGM/C-related decisions, and to assess predictors of households’ decision to cut or not cut the youngest daughter and the reasons for these decisions. METHODS: We drew on household survey data collected as part of a larger cross-sectional, mixed methods study in Sudan. The analytical sample comprised of data from 403 households that both reported that they had discussion around whether to cut the youngest daughter aged 19 years or younger and arrived at a decision to either cut or leave her uncut. Descriptive statistics summarizing the people involved in FGM/C-related decisions and the reasons for decisions are presented. We also present logistic regression analyses results summarizing predictors of households’ decision to leave the youngest daughter uncut. RESULTS: Household decision-making on FGM/C involved discussions among the nuclear and extended family, and non-family members. Mothers and fathers were found to be the key decision makers. A greater proportion of fathers were involved in instances where the final decision was to leave the daughter uncut. Thirty-six percent of households decided to leave the youngest daughter uncut. State of residence, mothers’ level of education and FGM/C status and exposure to FGM/C-related information or campaigns were associated with households’ decision to leave the daughter uncut. Health concerns were the most commonly cited reason for deciding not to cut their daughters (57%), while custom or culture was the most commonly cited reason for households deciding to cut their daughter (52%). CONCLUSION: FGM/C-related decisions result from deliberations that involve many people. Our findings underscore the important role that fathers play in decision-making and highlight the need to involve men in FGM/C programs. Findings also stress the need to understand and address the drivers of FGM/C.