Key Social Norms Take-aways This study illustrates that social norms—particularly those around cultural identity, marriageability, religious obligations, and control of female sexuality—strongly sustain the practice of FGM/C in Kenya. Despite growing awareness of health risks and legal prohibitions, communities are adapting through shifts in the practice (e.g., cutting at younger ages, medicalisation, and less severe forms), rather than abandoning it outright. These shifts represent both resistance to abandonment and, in some cases, transitional stages toward change. Social norms manifest as pressure from peers and family, with non-conformity punished by stigma, reduced marriage prospects, and community exclusion
Objectives The study aimed to understand shifts in the practice of FGM/C among families and health care providers in Kenya, focusing on three ethnic communities—Abagusii, Somali, and Kuria. Specific goals included exploring community views on FGM/C, reasons for its persistence, experiences of shifts in cutting practices and perceptions of re-infibulation.
Methods A qualitative cross-sectional design was used, anchored in grounded theory and social norms theory. Data were collected via 45 focus group discussions (FGDs), 54 in-depth interviews (IDIs), and 56 key informant interviews (KIIs) across urban and rural areas in Nairobi, Kisii, Garissa, and Migori counties. Participants included families with cut girls aged 0-15 years, women aged 15-49 years and their husbands and/or partners, as well as women and men aged 50 years and older. Community leaders, representatives from organisations, and health care providers were also interviewed. Analysis followed the framework method to identify themes and patterns.
Results Across all three communities, FGM/C is practised to uphold traditions, ensure marriageability, control female sexuality, and avoid social sanctions. The study identified three significant shifts: 1) cutting at younger ages, especially among Abagusii and Somalis, to avoid legal consequences and reduce physical resistance; 2) less severe forms of cutting, such as the Sunna cut or symbolic pricking, perceived as less harmful and more acceptable religiously and medically; and 3) medicalisation, primarily among Abagusii and Somali communities, conducted secretly by health professionals, often in private or at-home settings. These shifts are seen as safer alternatives but also as ways to maintain social conformity under increasing scrutiny. In contrast, the Kuria community largely resists these shifts, continuing public rites of passage controlled by elders.
Conclusions Effective abandonment strategies must go beyond individual-level education to address entrenched social norms, involve health care professionals and religious leaders, and target secrecy and medicalisation. Integrating social norms approaches into health and legal frameworks, alongside regional and community-specific strategies, is essential to disrupt the intergenerational transmission of FGM/C.