BMC Public Health. 2026 May 25. doi: 10.1186/s12889-026-27841-z. Online ahead of print.
ABSTRACT
BACKGROUND: Female genital mutilation (FGM) and child marriage (CM) remain pervasive in Ethiopia, driven by entrenched social norms, gender inequalities, and economic factors. Despite legal prohibition, national prevalence stands at 65% for FGM and 40% for CM. In response, Population Media Center (PMC) collaborated with the United Nations Population Fund (UNFPA) to implement a multimedia social and behavior change (SBC) intervention to raise awareness, shift attitudes and norms, and reduce the practice of FGM and CM in 4 targeted woredas of southern Ethiopia. This mixed-method study evaluates if and how the intervention was associated with changes in knowledge, attitudes, social norms, and practices related to FGM and CM.
METHODS: A mixed-methods evaluation was conducted in May 2025 using a comparative cross-sectional survey and qualitative interviews. A total of 403(205 exposed and 198 unexposed) survey participants were selected through systematic random sampling. For the qualitative components, 70 participants were purposively selected: 62 participants across 8 focus group discussions and 8 individual in-depth interviews. Respondents were categorized by exposure to the PMC multimedia intervention. Differences in knowledge, attitudes, behavioral intentions, social norms, and practices related to FGM and CM were analyzed. Chi-square tests determined statistical significance (p < 0.05), and quantitative insights were triangulated with qualitative insights.
RESULTS: Of 403 survey participants (205 exposed; 198 non-exposed; 73.7% female), the exposed group demonstrated significantly higher awareness about FGM and CM (93.2% vs. 84.6%, p < 0.001), stronger anti-FGM attitudes (90.2% vs. 81.4%, p = 0.014), and stronger anti-CM attitudes (83.4% vs. 78.1%, p < 0.001) compared to non-exposed participants. Total prevalence was 32.7% for FGM and 4.9% for CM. Qualitative data revealed that FGM persists covertly; families bypass legal restrictions by temporarily relocating girls to other villages for secret procedures. Despite high levels of awareness, deeply rooted sociocultural norms, marriageability myths, economic factors, social acceptability, and religious beliefs continue to perpetuate both practices.
CONCLUSION: Exposure to PMC multimedia SBC engagement was associated with significant differences in awareness and attitudes. However, the continued practice of FGM through covert means underscores the power of interlinked sociocultural and religious norms. Accelerating the abandonment of FGM and CM requires scaling community dialogues, empowering girls and young people, fostering intergenerational dialogue, coordinating stakeholder efforts, and strengthening legal enforcement to move beyond individual attitude shifts toward collective social norm change.
PMID:42178547 | DOI:10.1186/s12889-026-27841-z
