Female Genital Mutilation in Rural Regions of Iraqi Kurdistan: A Cross-Sectional Study

Objectives: Although female genital mutilation (FGM) is illegal in Iraqi Kurdistan, FGM continues to be performed frequently in Muslim communities in the region. The objectives of this study were to (1) determine the prevalence of FGM among females living in rural areas of Iraqi Kurdistan; (2) assess the attitudes toward FGM of mothers, village community leaders, and religious leaders; and (3) compare the prevalence of FGM by maternal education. Methods: In a cross-sectional, double-randomized study of rural areas in Iraqi Kurdistan, we used a semi-structured questionnaire to interview 1657 mothers of 5048 daughters, 192 mullahs (community leaders), and 386 mokhtars (religious leaders). We examined data on maternal education level, daughters' ages, whether daughters had experienced FGM, and attitudes about FGM. Results: A total of 2361 of 5048 (46.8%) daughters had experienced FGM. Of 1643 mothers, 565 (34.4%) supported FGM for their daughters in the future, although 825 of 1652 (49.9%) mothers were aware that it was illegal. Eighty-six of 192 (44.8%) mullahs and 382 of 399 (88.7%) mokhtars supported abandoning the practice of FGM. Support for FGM was significantly higher among uneducated mothers than among educated mothers (prevalence ratio [PR] = 1.45; 95% confidence interval [CI], 1.22-1.72; P < .001) and significantly higher among mothers with <= 9 years of education than among mothers with >9 years of education (PR = 1.66; 95% CI, 1.17-2.35; P = .003). Conclusions: FGM continues to be prevalent in rural areas of Iraqi Kurdistan. Public health interventions in this region are needed to improve knowledge about the harmful effects of FGM, its illegality, and the importance of prevention, particularly targeting leaders and households with low education levels.