Targeting a future generation free from female genital mutilation: A mixed-methods quasi-experimental study of an awareness intervention in central Tanzania

Female genital mutilation (FGM) persists in Tanzania, with the Dodoma Region having the country’s second-highest prevalence. This study evaluated a community-based educational intervention aimed at increasing FGM awareness and encouraging its abandonment among young adults (15–19 years) in Chamwino District, Dodoma, an important yet often overlooked group for fostering intergenerational change. We conducted a mixed-methods study with a primary quasi-experimental component: a single-arm, baseline-to-endline survey with a multi-stage cluster sample of 452 young adults who completed follow-up from schools and hospitals. Secondary components included a clinical audit of 3,770 delivering mothers to determine FGM prevalence and in-depth interviews with ten young adult mothers who had undergone FGM. The primary outcome was the change in the mean awareness score, analyzed using a paired t-test, with linear regression estimating associations with participants’ demographics. Changes in binary secondary outcome measures were analyzed using McNemar’s test, and the association between them was assessed with the chi-square test. The mean awareness score increased by 15.04 percentage points from 44.08% (SD = 15.85) at baseline to 59.12% (SD = 16.85), p < .001. At endline, 96.5% believed FGM is harmful, 50.9% reported its continuation, 97.6% knew it violates the human rights of girls and women, and 95.8% expressed a desire for abandonment. About 7.3% of women self-reported positive FGM status at baseline, while 16.6% were observed in 9-months. Qualitative analysis yielded three themes: 1) The hidden system, 2) Blood and lies, and 3) Intergenerational revolt. This theory-informed, community-engaged intervention significantly improved awareness and attitudes among more than 1,700 community members. However, qualitative findings revealed a persistent “hidden system” and a “critical power gap” among young adults, indicating awareness alone is insufficient. Sustainable abandonment requires integrating awareness campaigns with strategies that address structural power dynamics.