Targeting a future generation free from female genital mutilation: an awareness impacting observational study in central Tanzania

Female genital mutilation (FGM) persists in Tanzania, with the Dodoma Region having the countrys second-highest prevalence. This study evaluated a community-based educational intervention to increase FGM awareness and promote abandonment among young adults (15-19 years) in Chamwino District, Dodoma, a key but often neglected group for fostering intergenerational change. We conducted a mixed-methods study with a primary quasi-experimental component: a single-arm, baseline-endline survey with a multi-stage cluster sample of 452 completed follow-up young adults from schools and hospitals. Secondary components included a clinical audit of delivering mothers to determine FGM prevalence and in-depth interviews with ten FGM-positive young mothers. The primary outcome was the change in the proportion of participants with "Adequate Awareness" of FGM health risks; secondary outcomes included changes in attitudes and observed prevalence. Quantitative data were analyzed using paired t-test, McNemars test, chi-square, and logistic regression, reporting Adjusted Prevalence Ratios (aPRs), odds ratios, or mean differences with 95% Confidence Intervals (CIs), as appropriate. Qualitative data were thematically analyzed. The observed FGM prevalence was 16.6%. Adequate awareness increased from 1.3% to 14.6% (aPR = 5.45, 95% CI: 4.62-6.29, p<.001). Recognition of FGM as harmful rose from 91.2% to 96.7%, and the desire for its abandonment increased from 81.0% to 95.8% (both p<.001). Qualitative analysis yielded three themes: 1) The hidden system, 2) Blood and lies, and 3) Intergenerational revolt. A theory-informed, community-engaged intervention significantly improved knowledge and attitudes among more than 1,700 community members. However, qualitative findings revealed a persistent "hidden system" and a "critical power gap" among youth, indicating awareness alone is insufficient. Sustainable abandonment requires integrating awareness campaigns with strategies that address structural power dynamics.