Table 1 Summary of literature in the review

Abdelshahid and Campbell (2015) [31]

Egypt, rural communities in the Al Qalyoubeya governorate in the Nile Delta region and Benisweif governorate

Individual semi-structured in-depth interviews

Five fathers who had at least one daughter, all Muslim, age 22-60 years

To identify psychosocial factors that shape parents’ decisions to circumcise or not circumcise their daughters

Fathers acknowledge negative impact of FGM on marital sexual relationships. Female circumcision reflects the pride of parents. The practice is linked to a daughter’s maturity and acquisition of her feminine identity.

Non-circumcision is considered an obstacle to daughters’ marriage opportunities. Men believe girls who are not circumcised are promiscuous. FGM safeguards their daughter from engaging in adulterous relationships after marriage.

Although lack of sexual response is inconvenient and disturbing to the husband, the practice is still deemed important to ensure marriage fidelity and retain the husband’s feeling of security regarding his wife’s fidelity.

Parents find it difficult to deviate from the tradition in fear of rejection from the community. They continue to do it even though they may believe it is against their religion. They long for change but are held back by social pressure.

Al-Khulaidi et al. (2013) [22]

Yemen

Demographic Health Surveys, 1997 and 2003

Husbands of women aged 15–49, n = 4897 and n = 5908 in 1997 and 2003, respectively

To highlight attitudes of women of reproductive age (15-49) and their husbands towards the practice of FGM, and their association with the performance of FGM upon their daughters

More husbands thought FGM should be stopped in 2003 than in 1997 (p < 0.001). The percentage of couples that both agreed that FGM should be continued was reduced from 27.5 % in 1997 to 19.6 % in 2003 (p < 0.001). Husbands of women who had undergone FGM were supportive of FGM continuation, i.e. 60.1 and 49.5 % in 1997 and 2003, respectively. Both women and their husbands were more supportive regarding performance of FGM when the women had not undergone FGM (57.5 % and 47.4/%). When husbands of women with and without FGM did not agree with FGM, daughters were less likely to receive FGM in 1997 and in 2003.

Women and husbands’ attitudes to not support continuation of FGM were significantly associated with not having performed FGM on their daughters, regardless of women’s age and education. A daughter was more likely to receive FGM when the attitude towards FGM of her father was positive.

Asekun-Olarinmoye and Amusan (2008) [41]

Nigeria, Shao Community

Intervention study using a multistage sampling technique – pre-tested, structured questionnaire. Intervention stage consisted of health education sessions on FGM and its complications. Survey was supplemented by in-depth qualitative interview of traditional excisors.

159 and 181 men pre- and post-intervention, respectively

To determine level of practice of FGM and impact of a health education intervention

A greater proportion of men than women did not want FGM to be stopped in the pre-intervention stage of the study, but this proportion decreased significantly (from 53.5 to 25.4 %) in the post-intervention stage. Educational status, age and gender were statistically significantly associated with whether respondents had their daughters excised or not, while religion was not.

Berggren et al. (2006) [32]

Khartoum State, Northern Sudan

Descriptive and explorative study based on qualitative interviews with men and women between September 2002 and June 2003

Ten in-depth interviews with men of age between 28 and 47, all Muslim, of varying economic status and ethnic group

To explore men’s and women’s perceptions and experiences of FGC* with emphasis on reinfibulation (RI) after delivery

Both men and women felt they were victims of consequences of FGC. Men described their own complications, male sexual dissatisfaction, compassion for female suffering and perceived challenges to their masculinity. The psychological problems created by FGC increase women’s reluctance to discuss the issue. Men claimed that it was not until they were newly married that men experienced the irrevocable consequences of their wives’ FGC. Almost all men had had sexual experiences with uncircumcised women. Men explained they tried to compensate for the effects of FGC with other means of sexual stimulation. Almost all men stated they did not want their daughters to undergo FGC and no man wanted his daughters to undergo infibulation. None of the men considered RI to be his decision, but rather one of the mother, aunt or midwife. Men stated they had only limited influence. They believed primary FGC would decrease in the future, because men were starting to look for brides who had not undergone FGC. Men mentioned the silent culture between the sexes as one of the major obstacles for change.

Diop and Askew (2009) [23]

Rural areas of southern Senegal

Quasi-experimental, pre- and post-intervention longitudinal design with a comparison group; Village Empowerment Program included classes on human rights, problem-solving process, basic hygiene, women’s health

373 men pre-intervention in 2000; 85 men participants in intervention, 198 men nonparticipants in 2002; 82 men participants, 195 nonparticipants in endline in 2003; 184 men in baseline and 198 men in endline comparison group

To evaluate effect of community education program on community members’ willingness to abandon FGM/C**

Among all groups of men, fewer men intended to cut their daughter at endline. The change was greatest among the program’s participants (from 66 to 13 %) and least among men living in the comparison villages (from 78 to 56 %). At endline, men who had participated in the program were the least likely (20 %), and men in the comparison group the most likely (63 %) to express a preference for a woman who had been cut. Three-fourth of male participants indicated they would be willing to ask people in their community to end the practice and would support women calling for the abandonment of FGM/C. In the comparison group, less than 30 % of men indicated the same.

Fahmy et al. (2010) [33]

Egypt, two rural communities

Focus group discussions and qualitative interviews

99 men, including community and religious leaders, circumcisers, and health providers; over and under 35 years of age, Muslims and Christians, educated and non-educated

To examine the role of female sexuality in women’s and men’s continued support of FGM/C, and their perceptions of its sexual consequences

Men were concerned that women’s sexual pleasure was reduced, yet were worried that uncut women would be too sexually demanding, endangering their control over the sexual relationship. Almost all men and religious leaders stated that women had as much right to enjoy sex as men. Many religious leaders understood the complexity between sexual desire and circumcision. Many men complained about problems with their sexual lives in marriage.

Gage & Van Rossem (2006) [24]

Guinea

Descriptive quantitative: secondary analysis of cross sectional survey (Demographic Health Surveys)

1851 men aged 15-59, 41 % of men were never married; 84 % Muslim; men completed 3.7 years of schooling, two-thirds of participants lived in rural areas

To examine gender differences in attitudes toward the discontinuation of FGC and gain insights into factors supporting its elimination

53 % of men reported social approval as an advantage of FGC, 42 % believed FGC reduced likelihood of premarital sex, 61 % believed it was accepted by their religion, 38 % of men opposed the continuation of FGC, 51 % of men said FGC should continue. With each additional year of schooling, the odds of favouring the discontinuation of FGC increased substantially. Urban residence increased men’s odds of supporting discontinuation of FGC. As the number of perceived disadvantages increased, respondents became more likely to support the discontinuation of FGC. Islam was not a significant variable in any of the models.

Gele, Bente, & Sundby (2013) [34]

Somalia, Hargeisa and Galkayo districts

Qualitative descriptive study using unstructured interviews

11 Somali men aged ≥18

To explore the attitudes of Somalis to the practice of FC***

Almost all men supported continuation of FGM, mainly Sunna form, while rejecting Pharaonic type. Some men were aware of health implications of the latter and perceived there to be no complications with the Sunna type. It was believed to be a religious requirement. Abandonment process was preferred to come from communities rather than government and NGOs.

Gele, Bo, & Sundby (2013) [25]

Somalia, Hargeisa district

Descriptive, quantitative, cross-sectional study; structured questionnaires

108 men

To examine attitudes of Somali men towards FC

96 % of men preferred to marry circumcised women. However, 85 % preferred the Sunna form, 11 % preferred the Pharaonic form and only 2.8 % would choose uncircumcised women to be their wives. Only two men supported the discontinuation of all forms of FC. 96 % of men perceived FC to be a religious requirement. About 90 % of men knew about complications of FC. Men were divided on whether it prevented premarital sex, led to trustable marriage and preserved the dignity of girls.

Gele, Kumar, Hjelde, & Sundby (2012) [35]

Oslo, Norway

Qualitative descriptive study using focus groups and interviews

17 men under and over 25 years of age, majority secondary school-level education, few had college or university education

To explore the attitudes of Somalis living in Norway towards FC

Almost all men (n = 16) expressed their rejection of all types of FC. They had high knowledge of adverse health outcomes for women and men. Majority agreed that the practice was a traditional culture as opposed to religious practice, and that it reduced female sexual pleasure. There was no pressure to do it in Norway and it was prestigious not to be circumcised there. Men explained that many people in Somalia disliked FG but continued it due to social pressure. One man had believed FC prevented sexual violence towards girls.

Jaffer et al. (2006) [26]

Oman, secondary schools

Descriptive quantitative cross sectional survey; self-administered questionnaires

Nationally representative secondary school-based sample of 1670 boys, mean age 17.3

To examine the knowledge, attitudes and practices of Omani adolescents towards reproductive issues

Nearly 80 % of adolescent boys considered FGC to be necessary and important. This attitude was significantly higher in interior regions than the capital or coastal regions and was inversely associated with higher level of parent education, especially mothers’ education. Fifty-three percent and 28 % of boys were aware of the physiological and emotional puberty changes in boys and girls, respectively.

Johnsdotter et al. (2009) [36]

Sweden

33 semi-structured qualitative interviews, snowballing sampling and contacts with immigrant organisations

33 Ethiopian and Eritrean men and women, aged 28 to 69, almost as many men as women were interviewed; majority of men were Muslim

To explore attitudes toward FGC from a migration perspective

With the exception of two men, all men strongly rejected FGC. Many men emphasised a loss of ability by women to experience sexual pleasure. Men perceived FGC as devoid of meaning.

Johnson-Agbakwu et al. (2014) [37]

Somali refugee community in Maricopa Country, Arizona, United States

Community-based participatory research, involving qualitative interviews and focus group discussions

Somali-born male refugees over age 18

To examine perspectives of Somali men toward FGC and women’s childbirth experiences in a refugee community in the United States

Men expressed concern about lack of knowledge on FC by doctors. They felt responsible to advocate on her behalf of their wives and be cultural educators to healthcare providers. Men acknowledged strong matriarchal support of FGC. All but one man disagreed with the practice. They were aware of FGC-related morbidity. Men maintained they just agreed to the practice because they did not want to upset the mothers.

Kaplan, Cham et al. (2013) [38]

Gambia

Transversal descriptive study using face-to-face questionnaire

993 men, mean age 36.5, 96 % Muslim

To explore knowledge and attitudes of Gambian men towards FGM/C, as well as practices in their family and household; to promote knowledge on FGM/C and empower communities

72 % of men did not know FGM/C had negative impact on health. Awareness of health problems was higher among younger men who were less supportive of practice. These men also had lower intention of cutting their daughters and highest willingness of seeing men intervening in prevention.

Minority of men partook in decision-making, especially if they were not married. There were ethnic differences as to whether FGM/C was considered requirement by Islam.

Kaplan, Hechavarria et al. (2013) [27]

rural areas of The Gambia

A cross-sectional descriptive study with quantitative methodology

40 medical students from the Community-based Medical Programme

To examine knowledge, attitudes, and practices regarding FGM/C among health care professionals (HCP) working in rural settings in The Gambia

A significant proportion of Gambian HCP working in rural areas embraced the continuation of FGM/C

(42.5 %), intended to subject their own daughters to it (47.2 %), and reported having already performed it during their medical practice (7.6 %). Their knowledge, attitudes, and practices were shaped by sex and ethnic identity. HCP belonging to traditionally practicing groups were more favourable to the perpetuation and medicalisation of FGM/C, suggesting that ethnicity prevailed over professional identity.

Mitike and Deressa (2009) [28]

Somalia Regional State, Eastern Ethiopia

Community-based cross-sectional study

246 men, Somali refugees, in three refugee camps, all Muslim

To determine the prevalence and associated factors of FGM

More men (89 %) than women (55 %) positively viewed the usefulness of anti-FGM interventions. Fewer men (75 %) than women (91 %) had the intention to cut their daughters. Participation of the parents in anti-FGM interventions was statistically associated with lower practice and intention to cut their daughters.

Ouldzeidoune et al. (2013) [29]

Mauritania

DHS of Mauritania, 2000-2001

2,191 men aged 15 and 59

To investigate factors related to FGM and gavage practices and attitudes in Mauritania; to explore implications related to the protection of children’s rights and welfare

The overall prevalence of FGM was 77 % but varied depending on ethnicity. The majority of female and male respondents favoured continuation of the practice (64 and 70 %, respectively). Men and women in rural areas were more likely to approve of continued FGM. There was discordance between male and female beliefs that the opposite sex desired the continuation of the practice, with 37 % of women reporting that they though that males wanted to continue and 55 % of men reporting that they believed women wanted it to continue.

Ruiz et al. (2014) [39]

Spain

Descriptive study with ethnographic methodology using semi-structured interviews

9 men from Senegal and Mali, living in Spain, average age 35

To identify perspective of men on A/FGM**** to increase the cultural understanding of factors that support this practice

The results show that the A/FGM was conceived as a system of traditional cares subtended by several sexual, hygienic and religious factors. FGM was considered to guarantee faithfulness of wives in marriage and hence plays an important role in the maintenance of polygamy

Sagna (2014) [40]

Sierra Leone

DHS data of Sierra Leone, 2008

3123 men aged 15-59

To determine men’s and women’s attitude toward discontinuation of FGC

More men (36 %) compared to women (25 %) thought there were no benefits for a girl to undergo FGC. Men who saw no benefit had four times odds of supporting discontinuation. Men were significantly less likely to support discontinuation if they saw it as religious requirement.

Sakeah et al. (2006) [30]

Ghana

Simple random sample technique in a district of northern Ghana; questionnaire survey with two parts: part one to all men and part two to only those who had heard of FGM

1,406 men aged 12-24, 1,114 men aged 25 and above

To determine factors associated with men’s preference for circumcised women

18.8 % of men preferred women who had FGC. Men who preferred women with FGC were significantly more likely to be illiterate or have only primary or middle school education as compared to secondary and higher education. Men who preferred women to have FGC were significantly more likely to be Nankana compared to Kassesa ethnicity and more likely to report their religion as traditional compared to Christianity.