Key Social Norms Take-aways This study highlights that female genital mutilation (FGM) in Ethiopia’s Somali region is upheld by intersecting and context-specific social norms tied to religion, culture, femininity, and marriageability. The study applies social norms theory, distinguishing between empirical and normative expectations, and explicitly identifies FGM—especially infibulation—as a deeply entrenched norm. Girls and women perceive FGM as essential for social acceptance and respect, while boys and men emphasize its importance for marriageability and sexual control. Although religious leaders promote less invasive forms, such as sunna, traditional infibulation remains dominant in rural areas, reflecting cultural—not religious—justifications. The study emphasizes that interventions must target whole communities, address gendered power dynamics, and incorporate harm-reduction approaches in settings where immediate abandonment is unlikely.

Objectives To examine the patterning, drivers, and decision-making processes surrounding FGM in Ethiopia’s Somali region, and assess how social norms shape its persistence and potential for change.

Methods This mixed-methods study used survey data from 1,020 adolescents and their caregivers, and qualitative data from 259 participants including adolescents, caregivers, community leaders, service providers, and key informants. Quantitative data were analyzed descriptively and with t-tests; qualitative data were thematically analyzed using a grounded theory approach and MAXQDA software.

Results Nearly all surveyed girls who reported undergoing FGM (72%) had experienced infibulation, usually around age 9. Despite religious leaders advocating sunna over infibulation, traditional forms remain common—particularly in rural areas. Social pressures for conformity are strong: girls fear stigma, and mothers risk social shame if daughters are not cut. Girls and women often frame FGM as necessary for dignity and community respect, while boys and men focus on preserving girls’ virginity and suitability for marriage. A minority of respondents recognized health risks, but social risks of non-conformity were seen as more serious. There is also growing evidence of medicalization, with FGM increasingly performed in clinics.

Conclusions FGM in Somali region is maintained by a complex web of gendered social norms, with distinct motivations for girls/women and boys/men. Effective programming must move beyond individual behavior change or empowerment alone and instead prioritize collective, gender-transformative approaches that challenge cultural authority, reduce harm, and incrementally shift norms. Medicalization and partial infibulation reflect shifting practices but do not equate to abandonment; long-term, community-based strategies are essential to reduce and eventually eliminate FGM.