Medicalization of female genital mutilation in Egypt: Trends, drivers, and prospects for elimination.

Female genital mutilation (FGM) is a human rights violation that continues to affect over 86% of women and girls in Egypt. While it has declined, the practice is increasingly medicalized posing a significant challenge to abandonment efforts. This study aims to examine FGM medicalization in Egypt by exploring temporal trends, subnational patterns, underlying drivers, and the legal and policy context. We employed a mixed-methods approach, including a quantitative analysis of data from the 1995-2014 Egypt Demographic Health Surveys and the 2021 Egypt Family Health Survey, complemented by existing qualitative data among parents, healthcare providers, NGO program staff, and other stakeholders. Our findings demonstrate a marked decline in FGM prevalence over time and among younger cohorts. However, medicalization has risen sharply, reaching 83% in 2021. We identified three distinct typologies of subnational patterns in FGM prevalence and medicalization: (1) governorates with high FGM prevalence and high medicalization; (2) governorates where FGM persists but medicalization remains lower, and traditional practitioners like dayas - traditional cutters - are still commonly used; and (3) governorates with lower FGM prevalence but high rates of medicalization among those still undergoing the practice. Factors driving the medicalization of FGM in Egypt include persistent cultural beliefs that frame medicalized FGM as a safer option and means of beautification, parental deference to medical providers and a reliance on their "expertise" to determine the necessity for the procedure, limited awareness of FGM health consequences and legal prohibitions, and weak enforcement of penalties. To advance concrete action on medicalized FGM, a multi-level approach is essential-one that strengthens the enforcement of legal bans, integrates FGM into medical curricula and in-service training, and tailors interventions to subnational contexts based on the distinct patterns of FGM prevalence and medicalization across governorates.