Background: In Sudan, the prevalence of Female genital mutilation (FGM) is declining,
likely as a result of an ongoing changing attitude towards FGM as more Sudanese women
believe the practice should be discontinued amid growing awareness about its health dangers.
This study examined the geographical variation of attitude shifts toward the abandonment of
FGM, as well as a wide range of potential correlates towards the continuation of FGM (proFGM).

Methods: We conducted cross-sectional analyses of the successive DFID Sudan opinion poll
data sets (DFIDSOP) collected from 2012 to 2014, based on 4,741 individuals (age range:
18–75 in 2012/13 and 18-97 for 2014). We used Bayesian geo-additive mixed models to map
the spatial distribution and determine the odds ratios (OR) of positive attitude surrounding
FGM continuation, accounting for individual, household and state associated risk factors.
Results: During 2012/2013 and 2014 in Sudan, the overall percentage of people with a
positive attitude towards FGM continuation (Yes, FGM practice should continue) was 27.5%
and 18.3% respectively. In multivariable Bayesian geo-additive regression analyses, there
was a striking geographical variation within the country and between the two surveys. Factors
that were consistently associated with a higher pro-FGM attitude in both samples are:
education (no education) [OR & 95% Credible Region (CR): 2.15(1.03, 3.80) in 2012/13]
and primary/interim education [OR & 95% CR: 2.07(1.29, 3.18) in 2014] compared with
higher education, trust in local government (people with some trust [OR & 95% CR:
1.59(1.05, 2.64); in 2014] and people with little trust in 2014 [OR & 95% CR: 2.10(1.03,
4.04)] or people with little trust [OR & 95% CR: 1.47(1.03, 2.03) in 2012/13] compared with
people with no trust at all, identity (African identity [OR & 95% CR: 3.16(1.24, 6.48) in
2012/13] ) and tribal identity [OR & 95% CR: 3.23(1.75, 6.34) in 2014] compared with
Sudanese identity and the state of residence ( living in Sinnar, Red sea, and White Nile in
2012/13 and living in South Darfur, West Darfur and White Nile in 2014) compared with the
Northern state.
Other factors associated with a higher pro-FGM attitude in each sample were: in 2012/13,
household income (501-1000STG) [OR & 95% CR: 1.43(1.03, 2.36) compared with people
with income <100 STG, having a lot of trust in the police [OR & 95% CR: 1.71(1.11, 2.47) or
not at all [OR & 95% CR: 1.67(1.00, 2.89)] compared with people with some trust. In 2014
these factors were: large family size [OR & 95% CR: 1.72(1.19, 2.78)] compared with small
family size and having a little trust in the tribal leader [OR & 95% CR: 1.73(1.05, 2.80)]3
compared with people with some trust. People willing to vote in a general election were
associated with a reduced likelihood of being pro-FGM [OR & 95% CR: 0.65(0.46, 0.89)] in
2012/13.
Conclusions: The results demonstrate a significant decline and changing attitudes in Sudan
towards FGM, which can help accelerate the ongoing reduction of the practice, with high risk
estimates for a positive attitude towards the continuation of FGM in rural settings by uneducated
people with a strong tribal identity. The notable decrease in the practice of cutting
observed between the 2006 and 2010 Sudanese Household Surveys and the resulting shift in
attitude make a compelling case that attitudes and the practise of FGM can be changed.