Prevalence and determinants of the practice of genital mutilation of girls in Khartoum, Sudan

Background: Female genital mutilation (FGM) is widely practised in Sudan, despite many decades of attempts to prevent it. Aims: To estimate the prevalence of FGM, identify the types performed in Khartoum and investigate whether FGM is associated with various social factors. Methods: Girls aged 4-9 years (n=255) presenting to a paediatric emergency ward were recruited. A detailed history was obtained and full examination, including inspection of the genitalia, was performed to verify the type and extent of FGM. Results: Twenty per cent of the study group had undergone FGM, 50% of guardians indicated that it would be done later, and 29% stated that the child would not undergo FGM. In 66% of those who had undergone FGM, it was WHO type III. All operations had been performed by health professionals, mainly midwives. Those who had allowed or intended to allow their daughters to undergo FGM were of significantly lower socio-economic status (p=0.0008) and had spent significantly fewer years in school (both mothers, p=0.0015, and fathers, p=0.0266) than those who had not/would not. All who had undergone FGM were Muslims. None of the 16 Christians had undergone FGM. In girls over 7 years of age, there was a higher risk of having FGM in those who attended school than in those who did not. Conclusion: FGM is still practised widely in Khartoum and probably in many parts of northern Sudan and the type undertaken is often the most severe. Parental education, socio-economic level and religion are important determinants of the practice, but social pressure on parents and girls seems to play an important role.