Abstract
Female genital cutting (FGC) has major implications for women’s physical, sexual and psychological health, and eliminating the practice is a key target for public health policy-makers. To date one of the main barriers to achieving this has been an inability to infer privately-held views on FGC within communities where it is prevalent. As a sensitive (and often illegal) topic, people are anticipated to hide their true support for the practice when questioned directly. Here we use an indirect questioning method (unmatched count technique) to identify hidden support for FGC in a rural South Central Ethiopian community where the practice is common, but thought to be in decline. Employing a socio-demographic household survey of 1620 Arsi Oromo adults, which incorporated both direct and indirect direct response (unmatched count) techniques we compare directly-stated versus privately-held views in support of FGC, and individual variation in responses by age, gender and education and target female (daughters versus daughters-in-law). Both genders express low support for FGC when questioned directly, while indirect methods reveal substantially higher acceptance (of cutting both daughters and daughters-in-law). Educated adults (those who have attended school) are privately more supportive of the practice than they are prepared to admit openly to an interviewer, indicating that education may heighten secrecy rather than decrease support for FGC. Older individuals hold the strongest views in favour of FGC (particularly educated older males), but they are also more inclined to conceal their support for FGC when questioned directly. As these elders represent the most influential members of society, their hidden support for FGC may constitute a pivotal barrier to eliminating the practice in this community. Our results demonstrate the great potential for indirect questioning methods to advance knowledge and inform policy on culturally-sensitive topics like FGC; providing more reliable data and improving understanding of the “true” drivers of FGC.
Highlights
Over 200 million of the world’s female population currently live with female genital cutting (FGC), which involves the removal of, or injury to, their genital organs for non-medical reasons [1]
While ours not the first unmatched count technique (UCT) study to uncover hidden support for FGC, we suggest improvements to study design, and develop the UCT data collection methods to make them applicable in low income settings, something missing from the previous study
That the results presented here should be interpreted with caution, as there is a statistical requirement for large sample sizes when conducting unmatched count technique analyses [11]
Summary
Over 200 million of the world’s female population currently live with female genital cutting (FGC), which involves the removal of, or injury to, their genital organs for non-medical reasons [1]. High quality data on FGC behaviour and norms, which are essential to the design of effective intervention programmes, remain elusive. People may feel pressure to understate the prevalence of the practice or their preference for it (due to its illegality) [3], or to overstate it (due to social pressures, e.g. as a requirement of marriage). The possibility of both understatement and overstatement makes it especially difficult to assess to the prevalence and predictors of support for FGC at present
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