FGM in Sierra Leone: A silent epidemic undermining health, autonomy and equality

A comprehensive new study published in Women titled “Female Genital Mutilation in Sierra Leone: A Systematic Review of Cultural Practices, Health Impacts, and Pathways to Eradication” critically examines the enduring prevalence of Female Genital Mutilation (FGM) in Sierra Leone. The research evaluates empirical data from 2012 to 2025 and presents a call to action for community-rooted, context-sensitive approaches to combat a practice affecting over 80% of Sierra Leonean women and girls.

The systematic review compiles findings from eight peer-reviewed studies to explore the cultural, psychological, and health dimensions of FGM in Sierra Leone. While national and international advocacy efforts have intensified, the research reveals that entrenched social norms, weak legal enforcement, and limited healthcare access continue to obstruct progress toward eradication.

Why does FGM persist in Sierra Leone despite legal and advocacy efforts?

The study points to the powerful cultural entrenchment of FGM as a primary barrier to its eradication. Rooted in the rites of passage promoted by the Bondo society, a women-led secret institution, FGM is perceived as a critical marker of maturity, marital eligibility, and social integration. The authors emphasize that Bondo membership remains essential for many women to participate in community life, reinforcing widespread adherence to the ritual.

Despite Sierra Leone having ratified multiple international human rights agreements, the lack of robust national laws against FGM, and especially the poor enforcement of existing measures, has allowed the practice to continue largely unchecked. Traditional leaders and community elders often resist interventions they perceive as foreign impositions, defending FGM as a vital aspect of cultural identity. Women themselves, often socialized into viewing FGM as necessary and honorable, play a central role in its continuation, making the practice one of the few forms of gender-based violence that is both inflicted and perpetuated within the female community.

In addition to cultural pressures, socioeconomic vulnerabilities, including poverty, low literacy, and limited healthcare access, further entrench FGM. In rural areas, where the practice is most prevalent, health education is scarce and public health messaging has struggled to counter decades of normalized belief systems.

What are the health and social impacts of FGM on Sierra Leonean women?

The review highlights that FGM not only results in significant immediate physical complications, such as excessive bleeding, infections, and obstructed menstruation, but is also linked to long-term risks, including infertility and childbirth complications. Yet, many affected women avoid professional healthcare due to mistrust or lack of access, instead turning to traditional healers for treatment. This reliance on informal care underscores systemic inequalities and limits the capacity to mitigate complications.

Further compounding these risks is the observed link between early-age circumcision and heightened vulnerability to intimate partner violence (IPV). Women who undergo FGM between the ages of 10 and 14, especially when married early, exhibit markedly higher rates of IPV. These findings suggest that early FGM not only causes direct harm but also catalyzes a cycle of gendered subjugation and domestic abuse.

The study also addresses the controversial issue of medicalization. Though a minority of FGM procedures are now performed by health professionals, the researchers warn this trend risks legitimizing the practice under the guise of clinical safety. Instead of reducing prevalence, medicalization may entrench FGM further by sanitizing and institutionalizing a harmful tradition.

Critically, while higher education and women’s empowerment are often cited as protective factors, the findings show a nuanced picture. Education correlates with opposition to FGM, yet employment and economic activity do not always translate into rejection of the practice. In some cases, economically empowered women still expressed a willingness to circumcise their daughters, indicating that structural change must accompany normative transformation.

What intervention strategies can eradicate FGM without undermining cultural identity?

The study asserts that top-down interventions, often designed and implemented by international organizations, have had limited success in Sierra Leone, largely due to their failure to resonate with local realities. Effective eradication, according to the authors, requires grassroots engagement, cultural sensitivity, and the active inclusion of community voices.

A key recommendation is to embed health education and gender rights discussions into broader community development initiatives. Programs that have successfully altered attitudes elsewhere, such as community education efforts in Senegal, serve as models for Sierra Leone. These initiatives emphasize participatory learning, localized dialogue, and the integration of cultural leaders, healthcare providers, and survivors.

Empowerment Theory and the Intervention Based on Competences (IBC) model are proposed as guiding frameworks. These approaches promote psychological autonomy, critical reflection, and resistance to internalized norms, vital skills for women navigating societies that view FGM as a prerequisite for acceptance. Rather than simply opposing FGM, such frameworks empower women to reshape tradition in ways that uphold dignity and health.

The study also calls for the creation of alternative rites of passage, developed with cultural insiders, to provide meaningful replacements for FGM rituals. This approach avoids direct confrontation with cultural values, instead offering pathways to maintain community identity while eliminating harm.

Long-term success, the authors conclude, depends on bridging the gap between legal frameworks and cultural legitimacy. Laws alone are not sufficient; they must be reinforced through sustained, respectful engagement that empowers communities to make change from within.