The main aim of presenting the findings about the above four countries was to show how the picture about FGM appears contrasting at regional and sub-regional level in each selected country. The intention was to demonstrate and contrast the cultural mix. The findings mean that in West Africa (typified by Nigeria) the FGM preva- lence was on the increase whereas the situation in North Africa (e.g. Egypt) and West Africa (e.g. Senegal) and Central Africa (as exemplied by the Central African Republic) showed signs of slight decrease. The main lesson can be discussed in terms of national, sub-national as well as regional levels for each of the countries discussed. Besides lessons can also be drawn in terms of the socio-economic and cultural predictors of FGM for the four countries.
From the point of view of national trends, the overall prevalence for Egyptian women aged 15–49, for example, was estimated at 91.9% between 1995 and 2008, which differs slightly between the surveys. As pointed out in various analyses of DHS data in the four countries, behind these national averages lurk important varia- tions within countries. The highest FGM/C prevalence just noted in the case of Egypt appears to be an indication of the situation at the national level only, but at the sub-national plane within that country the range of FGM/C varied from 22.0% in Matrouh, 70.6% in North Sinai, 99.0% in Qena and 99.9% in Al Sharqia. These within country variations were also observed in Nigeria, Senegal and C.A.R. These variations are better investigated using our spatial analysis approach.
Moving now to the sub-national and regional trends within countries, it is remarkable that between 1995 and 2014 inclusive, the FGM/C rates observed (see the spread of maps for each of the countries) the steady increase in prevalence is the key feature noted in the case of Nigeria (West Africa). But the dataset points to a different story in relation to Egypt (North Africa), Senegal (West Africa) and the C.A.R—where the prevalence has decreased but only to a lesser degree. On balance, the FGM/C practice persists in the sense that the rates remain largely similar to what they were decades ago. This appears the case despite years of investment in cam- paigns designed to root out the practice. This lack of any substantial reduction is a serious cause for concern and it is something that is supported by an examination of standard deviation prediction maps of the predicted posterior. In other words, the findings mean that within each country a shift has occurred from lower FGM/C rates in the previous years to higher rates and vice versa. One could legitimately ask what factors might explain this upward trend and shift. It is a question, which goes far beyond the proper scope of this chapter. But, we can note, en passant, that the shift in attitude in countries like Senegal and others demonstrates these countries willingness to effectively ban FGM/C and avert the excruciating burden that this practice imposes on these countries. By contrast, in the case of regions where the change in attitude has been slow, much could be ascribed to the weight of traditions which are difficult to reform or abandon—especially in the light of the fact that many FGM/C-prone groups continue to refer to FGM as a route to a good marriage or a part and parcel of religious instructions.
As far as the socio-economic and cultural predictors of FGM/C in the four coun- tries are concerned, it is clear from existing studies that a slight decline has occurred in the subsequent years after 2014, although we must hasten to note the significant variations within regional and ethnic estimates. From the statistical point of view, therefore, the likelihood of FGM/C remains significantly higher among those popu- lations with no education. This was notably in the case among respondents within some ethnic groups-such as those in Northern parts of Nigeria, which is home to rural and poorer households. Here and in similar settings-as indicated by the prob- ability maps or standard deviations of the predicted posterior- the total residual spatial effects prove significant. For example, on the one hand, we note that the posterior probability maps of FGM/C risk are estimated at a 95 % credible interval.
The areas shaded in black on the maps suggest a significantly positive spatial effect associated with higher FGM/C risk. On the other hand, we observed from the maps that the areas shaded in white denote a significantly negative spatial effect, implying lower FGM/C risk. The remainders of the areas shaded in gray suggest that no sig- nificant effect exists with respect to FGM/C risk. The overall message is that the pattern of risk associated with FGM/C can readily be observed in each country as well as at regional and sub-national levels.
The foregoing analysis implies that monitoring this practice using national pro- portions can mask within country variability. That approach hardly assists in the design and implementation of policies and interventions at the local level. These findings provide new evidence to support the use of GIS methods in order to model the complex phenomenon of FGM/C around the world.
Overall, the findings, through use of advanced statistical techniques and meth- ods, were made particularly interesting and evidently novel. They are novel because traditional and conventional statistical techniques using said fixed effects variables for the location hardly capture the complexity behind the FGM/C phenomenon.
What we set out to do here with spatial analysis techniques is to make sense of this complexity and to unearth what burden lays behind the reality represented by tradi- tional statistical methods—namely that there are more behind official accounts of decrease of FGM/C prevalence than the traditional methods can uncover. Thus, through use of advanced modeling techniques, we have disentangled the within country dynamics of FGM/C, having regard to the complexity of intermingly cul- tures where this practice has to a varying degree been the most important social norm. Based on those techniques and methods we have shown that the existing household survey data provides misleading cross-sectional descriptive results. Such results tell us nothing about the extent to which the FGM/C prevalence is either decreasing or increasing at the sub-national and regional level.
However, one could object that where the spatial analysis demonstrates the correlation between where people live, their ethnicity, religion and whether or not they perform FGM/C, there is a danger that such a conclusion may add fuel to ethnic and religious strife by adding another dimension of ‘othering’. One response to this objection is to argue that such a finding, however sensitive, is directed to policy makers and governments responsible for addressing FGM in those regions.
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