How community dialogues influence norm change around female genital mutilation: a mediation analysis from a high- burden Kenyan setting

Abstract

ntroduction Female genital mutilation (FGM) remains highly prevalent in parts of Kenya, including Narok County, where marriageability expectations and social sanctions continue to sustain the practice. Although community- dialogue interventions are central to strategies to end FGM, evidence on their effects and mechanisms of influence remains limited. Methods We conducted a cross-sectional survey of 2658 respondents (1272 women and 1386 men) aged 15–60 years in Narok County in 2024. The primary exposure was participation in mixed-sex community dialogues with participation in couples-only dialogues as secondary exposure. Outcomes were measured using survey items adapted from established FGM and social norms literature, including a composite index of beliefs favourable to cutting and single-item measures of intention to cut a daughter, perceived marriageability expectations and opposition to FGM. Analyses used generalised estimating equations, predicted probabilities and generalised structural equation models to assess mediation pathways. Results Participation in community dialogues was associated with more progressive norms, including lower odds of endorsing pro-cutting beliefs (adjusted OR (aOR) 0.61, 95% CI 0.48 to 0.76), intending to cut a daughter (aOR 0.49, 95% CI 0.37 to 0.64) and perceiving uncut girls as unmarriageable (aOR 0.53, 95% CI 0.43 to 0.66), and higher odds of opposing FGM (aOR 2.39, 95% CI 1.84 to 3.11). Couples-only dialogues had smaller and less consistent associations. Predicted probabilities indicated substantial positive associations among participants exposed to community dialogues alone or combined with couples’ sessions. Mediation analysis showed that 88% of the effect of community dialogues on opposition to FGM indirectly linked through shifts in pro-cutting beliefs, intentions to cut and marriageability expectations, with intentions representing the strongest linkages. Conclusion Community dialogues are strongly associated with shifts in the social expectations and intentions that underpin FGM in a high-burden Kenyan context. These findings provide support for dialogue- centred strategies to eliminate FGM. Beliefs, intentions and marriageability norms are key intermediate indicators for monitoring normative change