Background Female Genital Mutilation (FGM) entails the removal, cutting and modification of the external female genitalia for non-medical reasons. The UN Sustainable Development Goal 5 (SDG 5.3) on gender equality calls for ending all traditional harmful practices, including FGM by 2030. This systematic review examined the prevalence of FGM and its subtypes globally, by WHO region, and by country.

Methods A systematic search using MeSH headings and keywords from inception to March 2, 2020 was undertaken in MEDLINE, PsycINFO, Web of Science, and EMBASE to identify studies that presented data on FGM prevalence. Only nationally representative studies were included in the meta-analysis. Abstract and full-text screening, quality assessment, and data extraction were undertaken independently by two reviewers. Pooled FGM prevalence was estimated by meta-analysis using a Freeman-Tukey double arcsine transformation and a random effects model using R software. FGM prevalence and types of FGM were presented separately by women and girls. Sub-group analysis was presented by WHO region.

Results Out of 3205 articles identified in the search, 28 nationally representative studies were included in the meta-analysis, and these studies included estimates for women and girls in 27 and 34 countries, respectively.The pooled prevalence estimate of FGM in women aged 15–49 was 40% (95% CI:26–55%; I² =100%) and 15% (95% CI:10–21%; I² =100%) in girls aged 0–14 years old. The country with the highest FGM prevalence in women was Guinea (97%) and the lowest, Uganda (0.3%). The highest prevalence in girls was in Mali (77%), and the lowest in Ghana (0%). The most common FGM type was having flesh removed, at 69% (95% CI:59–79%) of women and 70% (95% CI: 55–84%) of girls, followed by having the genital area sewn shut with 11% of women (95% CI:4–20%) and 9% of girls (95% CI:6–12%). The pooled prevalence by WHO region was 39% (95% CI: 24–56%) for women and 15% (95% CI:9–22%) for girls in Africa, and 52% (95% CI:8–93%) for women and 20% (95% CI:6–39%) for girls in the Eastern Mediterranean.

Conclusion There is large global variation in FGM, with the Eastern Mediterranean region recording the highest prevalence. Reassuringly, FGM is lower among girls, highlighting a declining trend in the practice. Some included reports may have underestimated FGM prevalence in girls due to continued risk; future studies should use age cohort analyses to monitor decline. Policy and community-level interventions are needed to meet SDG target 5.3.