title: Geographic Variation and Factors Associated with Female Genital Mutilation among Reproductive Age Women in Ethiopia: A National Population Based Survey.
abstract: BACKGROUND
  Female genital mutilation (FGM) is a common traditional practice in developing nations including Ethiopia. It poses complex and serious long-term health risks for women and girls and can lead to death. In Ethiopia, the geographic distribution and factors associated with FGM practices are poorly understood. Therefore, we assessed the spatial distribution and factors associated with FGM among reproductive age women in the country.
  
  
  METHODS
  We used population based national representative surveys. Data from two (2000 and 2005) Ethiopian demographic and health surveys (EDHS) were used in this analysis. Briefly, EDHS used a stratified, two-stage cluster sampling design. A total of 15,367 (from EDHS 2000) and 14,070 (from EDHS 2005) women of reproductive age (15-49 years) were included in the analysis. Three outcome variables were used (prevalence of FGM among women, prevalence of FGM among daughters and support for the continuation of FGM). The data were weighted and descriptive statistics (percentage change), bivariate and multivariable logistic regression analyses were carried out. Multicollinearity of variables was assessed using variance inflation factors (VIF) with a reference value of 10 before interpreting the final output. The geographic variation and clustering of weighted FGM prevalence were analyzed and visualized on maps using ArcGIS. Z-scores were used to assess the statistical difference of geographic clustering of FGM prevalence spots.
  
  
  RESULTS
  The trend of FGM weighted prevalence has been decreasing. Being wealthy, Muslim and in higher age categories are associated with increased odds of FGM among women. Similarly, daughters from Muslim women have increased odds of experiencing FGM. Women in the higher age categories have increased odds of having daughters who experience FGM. The odds of FGM among daughters decrease with increased maternal education. Mass media exposure, being wealthy and higher paternal and maternal education are associated with decreased odds of women's support of FGM continuation. FGM prevalence and geographic clustering showed variation across regions in Ethiopia.
  
  
  CONCLUSIONS
  Individual, economic, socio-demographic, religious and cultural factors played major roles in the existing practice and continuation of FGM. The significant geographic clustering of FGM was observed across regions in Ethiopia. Therefore, targeted and integrated interventions involving religious leaders in high FGM prevalence spot clusters and addressing the socio-economic and geographic inequalities are recommended to eliminate FGM.
authors.affiliation: Bahir Dar University, College of Medicine and Health Sciences; School of Public Health, Department of Reproductive Health, Bahir Dar University, Bahir Dar, Ethiopia.
authors.forename: Tesfaye
authors.initials: T
authors.lastname: Setegn
authors.affiliation: Ethiopian Public Health Associations, Addis Ababa, Ethiopia.
authors.forename: Yihunie
authors.initials: Y
authors.lastname: Lakew
authors.affiliation: Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom and Addis Ababa University School of Public Health, Addis Ababa, Ethiopia.
authors.forename: Kebede
authors.initials: K
authors.lastname: Deribe
mesh_terms: D000293:Adolescent; D000328:Adult; D019093:Circumcision, Female / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data*; D002987:Clitoris / Q000601:surgery*; D016000:Cluster Analysis; D004522:Educational Status; D005002:Ethiopia / Q000453:epidemiology; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007514:Islam / Q000523:psychology*; D016015:Logistic Models; D008875:Middle Aged; D015995:Prevalence