Community gender systems and daughters risk of female genital mutilation/cutting: New theory and application to Egypt

We proposed and tested a feminist social-ecological theory about daughters’ experience of female genital mutilation/cutting (FGMC) in Egypt, where over 90% of women ages 15–49 are cut. FGMC has potential adverse effects on demographic and health outcomes and has been defined as a human-rights violation. Contextual factors are important determinants of FGMC, but an integrated theory is lacking, and quantitative multilevel research is limited. We theorized that more favorable community-level gender systems, including gender norms opposing FGMCandexpanded opportunities for women outside of the family, would be associated with a daughter’s lower risk of FGMC and would strengthen the negative association of a mother’s opposition to FGMC with her daughter’s risk of cutting. Using a national sample of 14,171 mother-daughter dyads from the 2014 Egypt Demographic and Health Survey, we estimated multilevel discrete-time hazard models to test these relationships. Community gender norms opposing FGMC had significant direct, negative associations with the hazard that a daughter was cut, but women’s opportunities outside the family did not. Maternal opposition to FGMC was negatively associated with cutting a daughter, and these associations were stronger where community opposition to FGMC and opportunities for women were greater. Results provided good support for a gender-systems theory of the multilevel influences on FGMC. Integrated, multilevel interventions that address gender norms about FGMC and opportunities for women in the community, as well as beliefs about the practice among the mothers of at-risk daughters may be needed for sustainable declines in the practice.