Among the reproductive age women, 1,266 (17.46%) have said female genital mutilation should be continued and 1,710 (23.6%) of them believed that FGM is required by their religion. Nearly all women 7,157 (98.66%) were heard about FGM while 5,232 (72.19%) of them had no continuous media exposure (Table 1 and 2).
Female genital mutilation is spatially clustered in Ethiopia (Moran’s I=0.46, P<0.001). Accordingly, significant hotspot clusters of FGM were detected in Central Amhara, West and North-east Oromia, and East and North-east SNNP regions while cold spot clusters were found in most parts of Tigray, Harari, Dire Dawa and Gambela, including Central and South-West Afar regions (Figure 2). This finding is supported by other studies conducted in Ethiopia where FGM was spatially clustered with high spot clusters found in Central and East Amhara, North part of SNNP, East Oromia (20). Other studies conducted in Kenya(24), Senegal(23),Nigeria(25) all showed that FGM has significant spatial variation.
Determinant factors of female genital mutilation in Ethiopia
The fourth Model that includes both the individual and community level variables was the better fit as compared to others with high LLR.
Women older than 30 years had more than double (AOR=2.41, 95% CI: 1.78, 3.26) odds of having FGM compared to women of age ≤30 years. This finding was supported by different studies conducted in Ethiopia (20, 26), and Ghana (27). This might be due to the strong emphasis given by the government of Ethiopia in the late 20th and early 21st century to eliminate the practice of FGM through empowering women in different strategies including providing access to mass media and education. This would mean that women who were older have missed access to media exposure, health education, and other opportunities by health extension workers that can condemn the female genital mutilation.
With regard to occupation, women who are not currently working had 29 %( AOR=0.71, 95% CI: 0.55, 0.92) less odds of having FGM as compared to their counterpart. A number of studies however have reported that women who have occupation/are working had lesser odds of practicing FGM than those have no occupation (28-30). To best of our knowledge, there is no clear justification for this finding.
Those mothers who are never in union had 69% (AOR=0.31, 95% CI: 0.22, 0.44) reduced odds of having FGM compared to women who are currently in Union. This finding is in agreement with studies conducted in Sudan where not currently married women had less odds of having FGM (22). In Somali and Harari regional states of Ethiopia the communities circumcise the women to increase marriageability, to make them calm and sexually faithful for their husbands(28). The reason for being never in union reduces the odds of having FGM in Ethiopia might be the different cultural barriers like being circumcised makes females more faithful to their husbands (31). In African countries including Ethiopia, some communities believe that practicing FGM as a pre-request for marriage (17, 32, 33). Additionally, if women do not practice FGM, they might be excluded from the community (32).
Those women whose intention about FGM to be continued had nearly 3 (AOR= 2.86, 95%CI: 1.75, 4.68) times more odds of having FGM compared to those who think FGM to be stopped while those who think of FGM to be continued conditionally had 48% (AOR=0.52, 95% CI: 0.27,0.98) less odds of having FGM compared to those whose intention is FGM to be stopped. This might be due to mothers who support that FGM should be continued are old aged, and uneducated. Even if FGM is declared as an illegal act, male attitude (33), lack of female autonomy and older peoples believe of FGM as a source to keep virginity makes some older people to have intentions as FGM to be a continued arena (27). Those mothers living in a community where FGM is required by religion had 2 (AOR=1.99, 95% CI: 1.32, 2.99) times odds of having FGM as compared to women where FGM is not required by religion. No more than religion in Muslim religious followers(31)
In contrast to findings from other studies, mothers who had ever heard about FGM had nearly 3/4th (AOR=0.22, 95%CI: 0.08, 0.62) reduced odds of having FGM compared to their counterpart. This finding is against in studies conducted in Sudan where having more formal education reduces the odds of having FGM (22), Ghana (27). Many scholars have documented that religion and different traditional and cultural factors could affect the practice of FGM. Accordingly, our study noted that muslim and protestant religious followers had nearly four [AOR= 3.90, 95%CI: 2.5, 6.09) and nearly two times (AOR=1.76, 95%CI: 1.05, 2.97) increased odds of being circumcised as compared to orthodox religion followers. This finding is supported by studies conducted in South Ethiopia(26), Somali region of Eastern Ethiopia(29) , Ethiopia(20). Inaddtion, those mothers living in a community where FGM is required by religion had 2 (AOR=1.99, 95% CI: 1.32, 2.99) times odds of having FGM as compared to women where FGM is not required by religion. This finding was supported by different studies conducted elsewhere in South Ethiopia (26) , Ethiopia (20). The main reason for the increased practice of FGM in such religious community is related to the strong belief and attitude of the community that practicing FGM has religious basis. For instance, a girl who undergo circumcision is considered to be pure and can go for pray and it is considered as an obligation in Islamic religion (31).
In the context of women education, women who had no education had more than one and half (AOR=1.67, 95%CI: 1.03, 2.71) odds of having FGM as compared to those who had above secondary education. Similar results have been reported by different studies in South Ethiopia (26), and Ghana(27). It is evidenced that more educated women can save their daughters form circumcision (34). Mostly, women circumcised their children to get social acceptance and marriage prospect which might be related with the women’s self-autonomy that would mean more educated women had better decision making ability (35).