Effectiveness of a multimedia campaign in shifting community knowledge, attitudes, social norms, and practices of female genital mutilation and child marriage in Ethiopia

Abstract

Background

Female genital mutilation (FGM) and child marriage (CM) remain pervasive in Ethiopia, driven by entrenched social norms, gender inequalities, and economic factors. Despite legal prohibition, national prevalence stands at 65% for FGM and 40% for CM. In response, Population Media Center (PMC) collaborated with the United Nations Population Fund (UNFPA) to implement a multimedia social and behavior change (SBC) intervention to raise awareness, shift attitudes and norms, and reduce the practice of FGM and CM in 4 targeted woredas of southern Ethiopia. This mixed-method study evaluates if and how the intervention was associated with changes in knowledge, attitudes, social norms, and practices related to FGM and CM.

Methods

A mixed-methods evaluation was conducted in May 2025 using a comparative cross-sectional survey and qualitative interviews. A total of 403(205 exposed and 198 unexposed) survey participants were selected through systematic random sampling. For the qualitative components, 70 participants were purposively selected: 62 participants across 8 focus group discussions and 8 individual in-depth interviews. Respondents were categorized by exposure to the PMC multimedia intervention. Differences in knowledge, attitudes, behavioral intentions, social norms, and practices related to FGM and CM were analyzed. Chi-square tests determined statistical significance (p < 0.05), and quantitative insights were triangulated with qualitative insights.

Results

Of 403 survey participants (205 exposed; 198 non-exposed; 73.7% female), the exposed group demonstrated significantly higher awareness about FGM and CM (93.2% vs. 84.6%, p < 0.001), stronger anti-FGM attitudes (90.2% vs. 81.4%, p = 0.014), and stronger anti-CM attitudes (83.4% vs. 78.1%, p < 0.001) compared to non-exposed participants. Total prevalence was 32.7% for FGM and 4.9% for CM. Qualitative data revealed that FGM persists covertly; families bypass legal restrictions by temporarily relocating girls to other villages for secret procedures. Despite high levels of awareness, deeply rooted sociocultural norms, marriageability myths, economic factors, social acceptability, and religious beliefs continue to perpetuate both practices.

Conclusion

Exposure to PMC multimedia SBC engagement was associated with significant differences in awareness and attitudes. However, the continued practice of FGM through covert means underscores the power of interlinked sociocultural and religious norms. Accelerating the abandonment of FGM and CM requires scaling community dialogues, empowering girls and young people, fostering intergenerational dialogue, coordinating stakeholder efforts, and strengthening legal enforcement to move beyond individual attitude shifts toward collective social norm change.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-026-27841-z.

Background

Female genital mutilation (FGM) and child marriage (CM) are deeply rooted harmful practices (HPs) that persist despite legal prohibition and extensive advocacy efforts. FGM comprises all procedures involving the partial or complete excision of female genitalia or other injury to the female genital organs for non-medical reasons [1]. Globally, 230 million girls and women worldwide have undergone FGM, with the largest share in Africa (144 million), followed by Asia (80 million) and the Middle East (6 million). Every year, an estimated 4 million girls and women are subjected to FGM; without accelerated action, an estimated 27 million more girls will undergo FGM by 2030 [1, 2].

CM, defined as the formal marriage or informal union of a child under age 18, presents a similarly staggering global challenge. An estimated 640 million women alive today were married in childhood. Each year, 12 million adolescent girls are married before the age of 18, and, every 3 s, an adolescent girl gets married somewhere in the world [3, 4].

These HPs are driven by a combination of deep-rooted social norms, cultural beliefs, and religious traditions. These factors foster a sense of cultural identity that makes the abandonment of the practice elusive despite decades of efforts at community, national, and international levels. Since its launch in 2008, the United Nations Population Fund (UNFPA)–United Nations Children’s Fund (UNICEF) Joint Programme on the Elimination of Female Genital Mutilation has worked toward ending FGM by 2030, aligned with Sustainable Development Goal (SDG) 5, target 5.3. The joint program supported 17 countries; Burkina Faso, Djibouti, Egypt, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Kenya, Mali, Mauritania, Nigeria, Senegal, Somalia, Sudan, Uganda and Yemen. The program has provided prevention and protection services to nearly 7 million women as of February 2025. In addition, 48 million people have made public declarations to abandon the practice, and 220 million individuals were reached by mass media messaging on the issue [5].

However, global crises such as conflict, drought, and the COVID-19 pandemic have increased vulnerability to HPs such as FGM and CM. These crises not only increase the risk but roll back the progress of interventions due to economic shock, school closure, and fund adjustment. Modeled estimates indicate that the risk factors for FGM and CM intensified beginning in 2020, threatening to offset previous declines in prevalence. In 2022 alone, an estimated 12 million girls became child brides [6].

Despite a gradual decline in prevalence, the UNFPA–UNICEF Joint Programme reported that as of 2023, FGM remained widely practiced in Ethiopia. With 25 million girls and women affected, the country bears the largest absolute burden of FGM in Eastern and Southern Africa [7]. Nevertheless, historical data indicate a clear downward trajectory; according to data from the Ethiopian Demographic and Health Surveys (EDHS, 2016), FGM prevalence fell from 80% in 2000 to 74% in 2005, and further to 65% in 2016. However, despite this national progress, prevalence remains high and exhibits significant regional variation. For instance, the 2016 EDHS shows that prevalence reached 99% in the Somali region, while it was as low as 23% in Tigray. The age at which FGM is performed also varies significantly by geography; in the Afar region, it typically occurs within the first 7 days after birth, whereas in parts of southern Ethiopia, the practice is often delayed until a girl reaches marriageable age [8].

CM presents a similarly complex challenge. Current data indicate that 4 in 10 married women in Ethiopia entered into marriage or union before their 18th birthday. Consequently, Ethiopia is home to 15 million child brides, including 6 million who were married before the age of 15 [9]. While EDHS data show that marriage by age 15 decreased from 13% in 2005 to 8% in 2011 and further to 6% in 2016, rates of marriage by age 18 remained relatively stable between 2011 and 2016, at 41% and 40%, respectively. Significant disparities exist between urban and rural areas, with the median age at first marriage ranging from just below 16 years among women in Amhara to 24 years among women in Addis Ababa [8]. The consequences of these early marriages—and the resulting early pregnancies—are profound, leading to severe physical, psychological, and social harm for young girls and women.

Despite numerous interventions aimed at eliminating these HPs, prevalence rates have remained largely unchanged. In response, the National Costed Roadmap to End FGM and CM 2020–2024 was implemented in alignment with Proclamation No. 414/2004 of the Criminal Code of the Federal Democratic Republic of Ethiopia, which criminalizes the performance or procurement of FGM [10]. Beyond legal measures, scholars emphasize that community engagement, intersectoral collaboration, girls’ education and empowerment, and comprehensive social and behavior change (SBC) are the most transformative interventions for shifting community norms and ending these practices at the grassroots level [11, 12, 13].

Multimedia-based SBC interventions have proven effective in shifting public attitudes and behaviors toward social issues. Research grounded in the Sociological Ecological Model and Social Cognitive Theory highlights that carefully designed media content can significantly influence knowledge, perceptions, and social norms across multiple levels, from individual attitudes to community norms and institutional responses [14]. Pooled evidence found that sustained community exposure to anti-FGM and anti-CM campaigns through multimedia intervention resulted in individual persuasion, norm diffusion and increases in service linkages [15]. Similarly, evaluations of Ethiopian radio programs revealed significant reductions in harmful gender norms in communities exposed to consistent media messaging. Further evidence confirms that integrating media interventions with community dialogue amplifies impact, particularly in regions where FGM and CM are deeply entrenched [16]. Previous SBC communication interventions in Ethiopia and other African countries have demonstrated measurable reductions in FGM and CM prevalence following such media-led behavior change campaigns [17, 18].

Evidence remains scarce regarding the role of multimedia intervention on preventing FGM and CM, critical milestones for SDG 2030. While educational and economic empowerment initiatives are underway, behavioral change relies heavily on strategic information exposure. This study evaluates how a multimedia intervention influences awareness, attitudes, and social norms on FGM and CM among exposed and unexposed groups of population. The study also provides clear understanding of the persistent barriers of behavioral change, particularly the deep-seated social norms and gender inequalities sustaining FGM and CM. The results of this study contribute evidence on the association between multimedia SBC interventions and shifts in knowledge, attitudes, and social norms related to FGM and CM, and may serve as area-specific baseline information for monitoring and evaluating future interventions. The findings may also inform health planners and policymakers seeking to strengthen future interventions by integrating multimedia SBC programming with broader livelihood and economic empowerment initiatives for girls and women.

Intervention description

From January 2020 through June 2025, Population Media Center-Ethiopia (PMC-E), in collaboration with UNFPA, implemented a multimedia intervention to address FGM and CM in targeted districts of central, south, and southwest Ethiopia, including Mareko, Dalocha, Esera, and Dasenech. The multimedia intervention consisted of a radio talk show spot message, and promotional materials, complemented by capacity building, advocacy workshops, and radio listener groups (RLGs).

Prior to the intervention, formative audience research (FAR) was conducted to identify key behavioral barriers, enabling factors, and audience preferences. The FAR involved community-level consultations, focus group discussions, and key informant interviews with both primary audiences, including adolescent girls, boys, women of reproductive age, and displaced families, as well as influencer audiences, including religious leaders, elders, health extension workers, teachers, and local officials. Local government representatives, civil society organizations, and women’s groups also participated. FAR findings informed the intervention design by identifying key behavioral barriers, preferred communication channels, and enabling factors for change. These findings were not published in a formal report or policy brief but were used internally to inform intervention design. Building on these findings, the program identified lack of awareness, interlinked social norms, religiously rooted HPs, and other socioeconomic factors as primary drivers requiring strategic intervention.

Radio talk show program

Yalaleke Guzo (Unfinished Journey) utilized a magazine-style format combining community voices, expert advice, and dramatic storytelling. A total of 215 editions were produced and broadcast. Program elements included stakeholder interviews, book reviews, short plays, vox pop segments (short broadcast segments capturing diverse community voices on specific issues), poems, and narration. Broadcast via the Ethiopian Broadcasting Corporation (EBC) and local stations such as Silte and Jinka FM, the 30-minute program reached more than 5 million individuals. Messaging emphasized the health and social consequences of FGM and CM, legal prohibitions and enforcement, and the importance of parental involvement in HP abandonment through a storytelling approach.

To catalyze the program and promote engagement within the target communities, 36 RLGs were established, each consisting of 10 members. These groups, established in collaboration with the woreda Women and Children’s Affairs Office and school focal persons, targeted both youth and adults in separate formations, with members selected randomly from both in-school and out-of-school settings. Groups were equipped with multimedia tools to facilitate weekly collective listening sessions, during which members discussed program content and worked toward consensus on the issues raised. Where consensus could not be reached, members documented outstanding questions or concerns on a weekly feedback form submitted to the PMC project coordinator for follow-up. Over the course of the project, group members were assessed on knowledge, attitudes, and practices before and after participation; those demonstrating change were designated as change agents, with responsibility for cascading key messages to their families, neighbors, and the wider community.

Capacity building and advocacy workshops

To augment the reach and impact of the radio talk show at the community level, capacity-building workshops were provided to frontline health extension workers, social workers, and teachers. These were delivered annually at the woreda level and combined technical modules on the clinical, psychological, and legal dimensions of FGM and CM prevention with interactive methods including role plays, case studies, and group discussions to strengthen participants’ communication and counseling skills. Complementing these efforts, community-level advocacy workshops were conducted with clan and religious leaders, local government officials (specifically kebele and woreda women and social affairs leaders), elders, and former circumcizers. Facilitated by technical experts in a two-way dialogue format, these workshops bridged scientific evidence on the harms of FGM and CM with local cultural and religious contexts, culminating in formal public declarations and the establishment of community-led social sanctioning mechanisms, including locally approved by laws in instituting penalties for perpetrators. A total of 1,800 participants were involved in these capacity-building and advocacy efforts over the course of the project.

Broadcast of radio and TV spot messages

Radio and TV spot messages were critical for reinforcing key themes related to HPs. Thirty-three distinct spot messages were produced and broadcast across national and local media, reaching an estimated 2 million people.

Social and digital media amplification

To engage adolescents and youth who are increasingly active online, PMC utilized a multi-platform digital strategy encompassing Facebook, Telegram, YouTube, TikTok, and LinkedIn. PMC used monthly social media analysis to track message performance across all channels; data indicated that the intervention reached more than 3 million unique users and cultivated over 70,000 followers. To extend this reach to those with limited internet access, PMC also deployed an interactive voice response (IVR) system in collaboration with the digital consulting firm Viamo. This telephony-based digital component enabled 2,600 individuals to directly access messages about HPs via mobile phone.

Promotional material distribution

To reinforce the multimedia campaign, a diverse range of promotional materials—including booklets, flyers, posters, brochures, stickers, T-shirts, and billboard installations—were developed and distributed throughout the target areas. These materials featured key messages designed to inform and engage the public, while challenging prevailing community attitudes toward FGM and CM. The materials also incorporated human-interest stories of lived experiences to foster empathy and inspire collective action toward the abandonment of these practices.

Methods

Study setting

The evaluation covered 4 woredas (districts): Mareko and Dalocha (Central Ethiopia), Esera (Southwest Ethiopia), and Dasenech (South Ethiopia). These areas were purposefully selected due to their high documented prevalence of FGM and CM, as well as their inclusion in the 5-year PMC-E multimedia intervention.

Study design

A post-only mixed-methods design was employed to evaluate the interventions with key outcomes. The quantitative component used a comparative cross-sectional approach to analyze differences in key indicators between individuals either exposed or non-exposed to PMC multimedia programming. Household exposure status was determined by asking screening questions about exposure to the radio talk show, spot messages, promotional materials, social media, audio push messages (IVR), or PMC-trained change agents over the preceding 5 years. Participants who reported no exposure to any of these channels were categorized as the non-exposed group. The qualitative component addressed a complementary but distinct question: why does harmful practice persist despite increased awareness? Thematic analysis of focus group discussions and key informant interviews was oriented toward understanding the social, cultural, economic, and institutional factors that sustain FGM and CM, including concealment strategies, community enforcement mechanisms, persistent myths, and intergenerational social pressure, rather than replicating the outcome measures of the survey. The two data sources were analyzed separately and integrated at the interpretation stage, where qualitative findings are used to contextualize and extend patterns observed in the quantitative results.

Population and sampling

Quantitative survey sampling

The study population included women of reproductive age (15–49 years) and heads of households with at least 1 daughter. The sample size for the comparative cross-sectional survey was calculated using a two-population proportion formula, with a 16% expected difference key outcome measures between exposed and non-exposed groups, based on a comparable study conducted in the Sidama region of Ethiopia [16]. Calculations assumed 95% confidence, 80% power, a 5% margin of error, and a 10% non-response adjustment, yielding a minimum sample size of200 participants per group and a final recruited sample of 403 (203 exposed and 198 unexposed).

Eligible households were identified based on the presence of a woman of reproductive age (15–49) or household head, and at least one female child. PMC screening criteria were then applied to determine exposure status prior to recruitment, by assessing whether respondents had been exposed to the radio talk show “Yalaleke Guzo”, interactive voice response messages, advocacy or capacity-building activities, community forums facilitated by PMC, promotional materials, or TV and radio spot messages. Respondents included women, men, household heads, or older siblings aged 18 years or older. Participants were recruited using a systematic sampling technique, with the sampling interval calculated from the kebele household size and the allocated sample size. Sample sizes were distributed equally across clusters within each kebele.

Qualitative sampling

Sixteen qualitative activities were conducted, with 4 activities per woreda. These activities consisted of 8 key informant interviews/in-depth interviews (KIIs/IDIs) and 8 focus group discussions (FGDs) each composed of 5–11 participants, as illustrated in (Table 1). Participants were purposively selected to ensure diversity across gender, religion, residence, education, age, exposure status to PMC-E multimedia programming, and opinion leadership. FGD groups were stratified by age and social characteristics to ensure homogeneity within groups and promote open discussion; younger and older participants were not placed in the same groups, minimizing the risk of age-related dominance in discussions. Moderators were trained to encourage balanced participation throughout. Participant ages ranged from 21 to 62 years. Groups included advocates against FGM and CM, women and men residents with young children, community leaders, and woreda multisector leaders, ensuring both community-level and institutional perspectives were represented.

Table 1.

Sampling distribution of FGDs/KIIs/IDIs for the FGM-CM study, May 2025, PMC-E

Districts	FGDs	IDIs/KIIs	Total
Mareko	· Female residents (semi-urban) = 1 · Community leaders (town) = 1	· Advocate against FGM/CM (town) = 1 · WWSA representative = 1	4
Dalocha	· Male residents (town) = 1 · Woreda multisector leaders = 1	· Advocate against CM/FGM (rural) = 1 · Youth RLG change agent = 1	4
Esera	· Male residents (semi-urban) = 1 · Woreda multisector leaders = 1	· Victims of CM with trauma (town) = 1 · Female educated survivor of CM = 1	4
Dasenech	· Community leaders = 1 · Female residents (urban) = 1	· FGM practitioner = 1 · Youth RLG change agent = 1	4
Total	8	8	16

Abbreviations: CM Child marriage, FGD Focus group discussion, FGM Female genital mutilation, IDI In-depth interview, KII Key informant interview, PMC-E Population Media Center-Ethiopia, RLG Radio listener group, WWSA Woreda Women and Social Affairs Office

Data collection tools and procedures

A structured SurveyCTO-based questionnaire was deployed, translated into the local language (Amharic), and back-translated into English for analysis. The tool was adapted from validated scale items drawn from existing literature and grounded in social and behavior change communication theory. It comprised 6 sections: socio-demographic information, knowledge, attitudes, media exposure, behavioral intentions, and practices. The qualitative guides were aligned with the same theoretical constructs, exploring predisposing, enabling, and reinforcing factors influencing FGM and CM. These factors included beliefs, decision-making processes, gender norms, social pressures, multisectoral responses, and experiences with law enforcement.

Quantitative data were collected digitally via SurveyCTO by 13 trained, gender-balanced, enumerators and 4 supervisors. Qualitative data (FGDs, KIIs, and IDIs) were collected by 8 experienced researchers fluent in the local languages. Interviews and discussions were audio-recorded and transcribed verbatim to preserve the authenticity of the responses.

Data analysis and reporting

Quantitative data were analyzed using SPSS version 27. Knowledge, attitudes, and practices were assessed using composite scales with validated items. The primary outcome variables, including knowledge, attitudes toward FGM and CM and intention to practice, were measured by scale and the overall scores calculated from the summation of reliable items. Knowledge was assessed using a 3-point scale (True = 2, Don’t Know = 1, False = 0) on 13 items, where scoring was adjusted based on statement polarity: correct identification of facts and the rejection of myths were both awarded maximum points, while “Don’t Know” served as a neutral midpoint to distinguish uncertainty from misinformation. Similarly, attitude and intention of prevention variables were measured using a 5-point Likert scale (1 = Strongly Disagree to 5 = Strongly Agree) on 16 items, with scores calculated by aggregating agreement with pro-prevention statements and disagreement with anti-prevention (pro-practice) statements through reverse-coding. Final outcomes were expressed as cumulative percentages, providing a standardized metric for evaluating the intervention difference across diverse social and behavioral dimensions. The prevalence of FGM and CM was assessed for all adolescent girls and women within selected households by recording their age at marriage and the age at which FGM was performed. To measure post-intervention effects, the analysis distinguished between lifetime prevalence, representing the cumulative number of individuals who have ever undergone these practices, and period prevalence, which specifically tracked incidents occurring within the intervention timeline from January 2020 to June 2025. Lifetime prevalence of FGM was defined as the proportion of women aged 15–49 who self-reported having undergone the practice, and girls’ prevalence of FGM as the proportion of girls aged 0–14 whose parents or guardians reported the practice on their behalf. Prevalence of CM was defined as the proportion of women aged 20–24 who reported having been married before age 18.

Finally, comparative assessments examined mean and proportion differences between exposed and non-exposed groups across those variables. Statistical significance was determined using chi-square tests and related measures of association. Qualitative data were analyzed thematically using ATLAS.ti version 7.5.18 to identify contextual insights. Each transcript was coded independently by the lead coder, with a subset of the material double-coded by two independent researchers to ensure reliability. Discrepancies were resolved through consensus discussions, during which code definitions were refined until a high level of inter-coder agreement was reached. Finally, quantitative and qualitative results were triangulated to interpret changes in knowledge, attitudes, social norms, and behavioral practices. These findings informed policy and communication recommendations to promote community-level normative change.

Scientific validity and rigor

Quantitative data quality was ensured through pre-testing, expert content validation, and rigorous supervision. Internal consistency of composite scales was confirmed via Cronbach’s alpha (ranging from 0.72 to 0.87 across constructs such as knowledge and attitudes), confirming reliability. The SurveyCTO platform incorporated real-time validation, GPS verification, and logic checks. Enumerators received intensive training, and supervisors conducted frequent data audits. Triangulation across FGDs, KIIs, and quantitative surveys enhanced validity.

Qualitative rigor was maintained through multiple strategies to ensure credibility, dependability, transferability, and confirmability. These strategies included prolonged engagement, peer debriefing, member checking, reflexivity, and thick description. Draft reports underwent internal review and verification by PMC-E staff.

Ethical considerations

In accordance with the Declaration of Helsinki, this research is ethically cleared by the Institutional Review Board (IRB) of Jimma University (Ref: JUIH/IRB/0492/25). Informed consent and assent were obtained from all participants. Confidentiality was maintained through the use of pseudonyms and anonymized transcripts.

Results

Socio-demographic characteristics and household profile

403 individuals participated in the survey, with near-equal representation in the intervention-exposed (50.9%) and non-exposed (49.1%) groups. The majority of participants were female (72.9%), married (76.7%), and urban residents (86.4%). Educational attainment varied widely: 11.7% had no formal education, while 12.7% held a bachelor’s degree or higher. The predominant religious affiliations were Orthodox Christianity (47.6%) and Islam (32.5%). Respondents’ primary occupations included housewife (34.0%), private business operator (24.3%), or government employee (21.6%). Over half of households (55.6%) were categorized as poor by a composite wealth index derived from household asset ownership and living conditions, including housing quality, livestock, household utensils, and land, using Principal Component Analysis. Households were grouped into three wealth categories: poor (combining the two lowest quartiles), moderate, and high income. The average household size was 5.88 members. Community engagement was high, with 91.8% of respondents affiliated with traditional support groups such as Idir (Table 2). Qualitative participants ranged in age from 21 to 62 years, and FGDs comprised 5–8 individuals per session.

Table 2.

Socio-demographic characteristics of the respondents and household profile, PMC-E evaluation study, target districts, May 2025 (N = 403: exposed = 205, non-exposed = 198)

Variables	Exposed (n = 205)	Non-exposed (n = 198)	Total (N = 403)	Statistics
District
Dasenech (South Omo)	55 (26.8%)	48 (24.2%)	103 (25.6%)	χ² = 0.04, p = 0.84
Mareko Special Woreda	50 (24.4%)	50 (25.3%)	100 (24.8%)
Essera (Dawro Zone)	50 (24.4%)	50 (25.3%)	100 (24.8%)
Dalucha (Silte Zone)	50 (24.4%)	50 (25.3%)	100 (24.8%)
Residence/Kebele
Urban	178 (86.8%)	170 (85.9%)	348 (86.4%)	χ² = 0.36, p = 0.55
Semi-urban town	27 (13.2%)	28 (14.1%)	55 (13.6%)
Sex
Female	149 (72.7%)	145 (73.2%)	294 (72.9%)	χ² = 0.01, p = 0.92
Male	53 (25.9%)	52 (26.3%)	105 (26.1%)
Marital status
Married	156 (76.1%)	153 (77.3%)	309 (76.7%)	χ² = 0.09, p = 0.99
Single	25 (12.2%)	24 (12.1%)	49 (12.2%)
Widowed	10 (4.9%)	10 (5.1%)	20 (5.0%)
Divorced	11 (5.4%)	11 (5.6%)	22 (5.5%)
Religion
Orthodox	97 (47.3%)	95 (48.0%)	192 (47.6%)	χ² = 0.04, p = 0.99
Muslim	66 (32.2%)	65 (32.8%)	131 (32.5%)
Protestant	38 (18.5%)	37 (18.7%)	75 (18.6%)
Other (Traditional)	1 (0.5%)	0 (0%)	1 (0.2%)
Education
No formal education	24 (11.7%)	23 (11.6%)	47 (11.7%)	χ² = 0.03, p = 1.00
Able to read/write	26 (12.7%)	25 (12.6%)	51 (12.7%)
Primary (1–8)	54 (26.3%)	52 (26.3%)	106 (26.3%)
Secondary (9–12)	41 (20.0%)	40 (20.2%)	81 (20.1%)
Tertiary (certificate > 12)	15 (7.3%)	14 (7.1%)	29 (7.2%)
Tertiary (college diploma)	17 (8.3%)	17 (8.6%)	34 (8.4%)
Tertiary (bachelor’s degree or higher)	26 (12.7%)	25 (12.6%)	51 (12.7%)
Occupation
Housewife	69 (33.7%)	68 (34.3%)	137 (34.0%)	χ² = 0.02, p = 0.99
Merchant/private business	50 (24.4%)	48 (24.2%)	98 (24.3%)
Government employee	44 (21.5%)	43 (21.7%)	87 (21.6%)
Student	15 (7.3%)	15 (7.6%)	30 (7.4%)
Farmer	14 (6.8%)	14 (7.1%)	28 (6.9%)
Daily laborer	5 (2.4%)	4 (2.0%)	9 (2.2%)
Other	5 (2.4%)	4 (2.0%)	9 (2.2%)
Spouse/HH head education
No formal education	20 (9.8%)	20 (10.1%)	40 (9.9%)	χ² = 0.01, p = 1.00
Able to read/write	22 (10.7%)	22 (11.1%)	44 (10.9%)
Primary (1–8)	39 (19.0%)	38 (19.2%)	77 (19.1%)
Secondary (9–12)	33 (16.1%)	32 (16.2%)	65 (16.1%)
Tertiary (certificate > 12)	13 (6.3%)	12 (6.1%)	25 (6.2%)
Tertiary (college diploma)	23 (11.2%)	22 (11.1%)	45 (11.2%)
Tertiary (bachelor’s degree or higher)	31 (15.1%)	30 (15.2%)	61 (15.1%)
Not applicable	14 (6.8%)	14 (7.1%)	28 (6.9%)
Spouse/HH head occupation
Merchant/private business	54 (26.3%)	53 (26.8%)	107 (26.6%)	χ² = 0.01, p = 0.99
Government employee	53 (25.9%)	52 (26.3%)	105 (26.1%)
Farmer	35 (17.1%)	34 (17.2%)	69 (17.1%)
Housewife	27 (13.2%)	26 (13.1%)	53 (13.2%)
Daily laborer	6 (2.9%)	6 (3.0%)	12 (3.0%)
Other	5 (2.4%)	4 (2.0%)	9 (2.2%)
Not applicable	14 (6.8%)	14 (7.1%)	28 (6.9%)
Wealth Index
Poor	113 (55.1%)	111 (56.1%)	224 (55.6%)	χ² = 0.05, p = 0.98
Medium	46 (22.4%)	45 (22.7%)	91 (22.6%)
Rich	43 (21.0%)	42 (21.2%)	85 (21.1%)
HH Profile (Mean ± SD)
Household size	5.69 ± 1.74	5.91 ± 1.93	5.88 ± 1.80	-
Male children	2.13 ± 1.21	2.15 ± 1.49	2.14 ± 1.44	-
Female children	2.25 ± 1.09	2.23 ± 1.19	2.24 ± 1.15	-
Teenage girls (10–17 years)	0.95 ± 0.73	0.93 ± 0.66	0.94 ± 0.68	-
Membership in social groups
Idir	187 (91.2%)	183 (92.4%)	370 (91.8%)	χ² = 0.21, p = 0.65
Savings and loan group	137 (66.8%)	134 (67.7%)	271 (67.2%)	χ² = 0.04, p = 0.84
WDA/HDA	49 (23.9%)	48 (24.2%)	97 (24.1%)	χ² = 0.01, p = 0.93
Women’s income group	40 (19.5%)	39 (19.7%)	79 (19.6%)	χ² = 0.00, p = 0.96
Senbetie/mahber/debo	33 (16.1%)	32 (16.2%)	65 (16.1%)	χ² = 0.00, p = 0.99
Women’s militia group	22 (10.7%)	22 (11.1%)	44 (10.9%)	χ² = 0.01, p = 0.91
Model family	18 (8.8%)	18 (9.1%)	36 (8.9%)	χ² = 0.01, p = 0.92
Adolescent group	8 (3.9%)	7 (3.5%)	15 (3.7%)	χ² = 0.04, p = 0.84

Abbreviations: HDA Health Development Army, HH Household, SD Standard deviation, WDA Women’s Development Army

Socio-behavioral shifts by exposure to the PMC-E media intervention

Knowledge about FGM and CM

Overall knowledge about FGM and CM was significantly higher among the exposed group (93.2%) compared to the non-exposed group (84.6%; p < 0.001), representing an 8.6% point difference. Significant differences were also observed across several specific knowledge items between exposed and non-exposed groups. The exposed group demonstrated better understanding of the mental health effects of FGM, such as anxiety and depression (96.1% vs. 83.8%; mean = 3.02, p < 0.001), were more likely to reject the myth linking FGM to chastity or moral character (mean = 3.05, p < 0.001), and better understood that FGM causes physical harm (p = 0.049).

Regarding CM, the exposed group demonstrated better awareness of the economic benefits of delaying marriage (86.8% vs. 77.3%; mean = 3.13, p = 0.009), understood that CM increases maternal mortality (98.4% vs. 90.5%. p < 0.0001), and recognized that CM increases spousal abuse (95.1% vs. 87.4%, p = 0.005) (Table 3).

Table 3.

Knowledge about FGM and CM, PMC-E evaluation study, target districts, May 2025 (N = 403: exposed = 205, non-exposed = 198)

Knowledge variable about FGM and CM	Exposed (n = 205)	Non-exposed (n = 198)	Total (N = 403)	p-value
FGM causes lifelong physical harm (True)	204 (99.5%)	192 (97.0%)	396 (98.3%)	0.049
FGM leads to mental health issues (True)	197 (96.1%)	166 (83.8%)	363 (90.1%)	< 0.001
FGM increases HIV risk (True)	205 (100%)	195 (98.5%)	400 (99.3%)	0.056
FGM is criminalized in Ethiopia (True)	201 (98.0%)	189 (95.5%)	390 (96.8%)	0.123
FGM enhances chastity/moral character (False)	163 (79.5%)	127 (64.1%)	290 (72.0%)	< 0.001
Religious scriptures require FGM (False)	182 (88.8%)	167 (84.3%)	349 (86.6%)	0.178
FGM hinders sexual health (True)	165 (80.5%)	149 (75.3%)	314 (77.9%)	0.197
CM interrupts education (True)	197 (96.1%)	181 (91.4%)	378 (93.8%)	0.042
Girls under 18 are biologically mature for marriage (False)	175 (85.4%)	159 (80.3%)	334 (82.9%)	0.162
CM increases maternal mortality (True)	202 (98.5%)	179 (90.4%)	381 (94.5%)	< 0.001
CM increases spousal abuse (True)	195 (95.1%)	173 (87.4%)	368 (91.3%)	0.005
CM is outlawed in Ethiopia (True)	201 (98.0%)	188 (94.9%)	389 (96.5%)	0.082
Delaying marriage improves girls’ independence (True)	178 (86.8%)	153 (77.3%)	331 (82.1%)	0.009
Comprehensive knowledge (mean % correct)	93.2%	84.6%	88.9%	< 0.001

“I don’t know” responses were merged with “No” due to low percentages across all items. Values in bold indicate statistical significance (p < 0.05)

Abbreviations: CM Child marriage, FGM Female genital mutilation, PMC Population Media Center, PMC-E Population Media Center-Ethiopia

The qualitative findings were consistent with the survey results. FGD and IDI participants reported that advocacy through relatable body analogies helped the community better understand the severity of FGM.

“I gave awareness… with example about losing of one finger from five. As your four fingers do no work appropriately, cutting organ like as fingers it doesn’t work task. Moreover, I also use sensory body to give analogy of harm. For example, there are five sense organs. From five sense organs, as eye helps to see, she is losing one of reproductive organs… Therefore, when removed that organ it left with scar.” (IDI, Mareko, Advocate).

Participants also noted that youth had gained awareness of legal protection through various channels and have started to resist HPs.

“I joked with my daughter about circumcising her. She said, ‘I will call the police, and you’ll be arrested.’ That’s how much awareness they have from school.” (Community Leader FGD, Mareko).

However, misconceptions about medical, sociocultural, and religious justifications for FGM persisted among older generations. Participants reported that older community members believe that FGM ensures marriageability and controls sexual desire.

“If she is not circumcised, no man will marry her. They say she is not clean, she is rebellious. That’s why even educated families still do it.” (IDI, RLG).

“People say if not circumcised, she will be over-stimulated, she won’t control herself, she will break household items. These beliefs are stronger than science here.” (Men’s FGD, Esera).

Some elders and parents associate FGM with ensuring community acceptance and honor.

“First an uncircumcised woman loses her honor; she is ostracized from society… she cannot find a husband. That is why she is circumcised.” (KII, Dasenech, FGM Practitioner.

Similarly, others viewed FGM as deeply intertwined with community concepts of bodily cleanliness and modesty.

“They say the girl has a bad smell if not circumcised. They say she’s not pure. These are myths, but they are very powerful in the community.” (IDI, Esera, FGM Survivor).

Despite several awareness-raising campaigns via different channels, some participants framed FGM as a religious obligation.

“There are opinions of scholars who say it should be done, although others say it’s not required.” (Community Leader FGD, Mareko).

Attitudes towards FGM and CM

FGM

The exposed group demonstrated significantly greater rejection of sociocultural justifications for FGM compared to the non-exposed group. Exposed participants were less likely to agree with common pro-FGM beliefs, including that FGM ensures virginity (0.0% vs. 1%, χ² = 3.91, p = 0.048) or improves marriage prospects (1.0% vs. 1.5%, χ² = 0.24, p = 0.625). The exposed group also showed higher recognition of FGM’s harms: 83.4% acknowledged its health risks (vs. 72.2%, χ² = 7.33, p = 0.007), 83.9% recognized the psychological trauma it causes (vs. 68.2%, χ² = 11.42, p < 0.001), and 93.7% rejected the notion that condemning FGM’s harms is “weak” (vs. 78.3%, χ² = 13.74, p < 0.001).Exposure to the campaign was significantly associated with more progressive attitudes toward FGM. Specifically, participants reached by the program were significantly less likely to associate FGM with the prevention of family shame (0.5% vs. 5.1%, p = 0.005) and were more likely to recognize its link to psychological trauma and anxiety (83.9% vs. 68.2%, p < 0.001).

However, there were no significant differences between groups regarding religious justifications for FGM, perceptions of fairness around marriage benefits, or beliefs about sexual autonomy (Table 4).

Table 4.

Attitude toward FGM statements, PMC-E evaluation study, target districts, May 2025 (N = 403: exposed = 205, non-exposed = 198)

Attitudinal statement about FGM	Response	Exposed (n = 205)	Non-exposed (n = 198)	χ²	p-value
FGM ensures a girl’s virginity and moral behavior.	Agree	0 (0.0%)	2 (1.0%)	3.91	0.048
	Disagree	205 (100%)	196 (99.0%)
Ensuring virginity and moral behavior through FGM is valuable.	Agree	5 (2.4%)	5 (2.5%)	0.00	0.955
	Disagree	200 (97.6%)	193 (97.5%)
FGM increases a girl’s marriage prospects by cleansing her body.	Agree	1 (0.5%)	5 (2.5%)	2.85	0.091
	Disagree	204 (99.5%)	193 (97.5%)
Improving marriage prospects through FGM is fair.	Agree	2 (1.0%)	3 (1.5%)	0.24	0.625
	Disagree	203 (99.0%)	195 (98.5%)
FGM is a religious requirement.	Agree	1 (0.5%)	4 (2.0%)	1.93	0.165
	Disagree	204 (99.5%)	194 (98.0%)
Fulfilling religious obligations through FGM is just.	Agree	1 (0.5%)	2 (1.0%)	0.37	0.542
	Disagree	204 (99.5%)	196 (99.0%)
FGM protects the family from shame.	Agree	1 (0.5%)	10 (5.1%)	7.90	0.005
	Disagree	204 (99.5%)	188 (94.9%)
Avoiding family shame through FGM is acceptable.	Agree	3 (1.5%)	8 (4.0%)	2.52	0.112
	Disagree	202 (98.5%)	190 (96.0%)
FGM causes long-term physical and reproductive health problems. ** *	Agree	171 (83.4%)	143 (72.2%)	7.33	0.007
	Disagree	34 (16.6%)	55 (27.8%)
Condemning FGM’s health harms is a sign of weakness.* *	Agree	13 (6.3%)	43 (21.7%)	10.12	0.001
	Disagree	192 (93.7%)	155 (78.3%)
FGM leads to psychological trauma and anxiety. * *	Agree	172 (83.9%)	135 (68.2%)	13.74	< 0.001
	Disagree	33 (16.1%)	63 (31.8%)
Causing FGM’s psychological harms is unfair.* *	Agree	163 (79.5%)	141 (71.2%)	3.74	0.053
	Disagree	42 (20.5%)	57 (28.8%)
FGM is necessary for community acceptance.	Agree	5 (2.4%)	14 (7.1%)	4.81	0.028
	Disagree	200 (97.6%)	184 (92.9%)
Gaining community acceptance through FGM is just.	Agree	3 (1.5%)	8 (4.0%)	2.52	0.112
	Disagree	202 (98.5%)	190 (96.0%)
FGM restricts women’s sexual autonomy. * *	Agree	112 (54.6%)	92 (46.4%)	2.69	0.101
	Disagree	93 (45.4%)	106 (53.6%)
Restricting sexual autonomy through FGM is important.	Agree	11 (5.4%)	5 (2.5%)	2.13	0.144
	Disagree	194 (94.6%)	193 (97.5%)
Overall anti-FGM attitude (% with attitudes against FGM) ±		90.2%	81.4%	6.01	0.014

* * Anti-FGM statement (agreement indicates positive attitude toward abandoning FGM)

^± Composite measure of overall attitude based on responses across all items

Abbreviations: FGM Female genital mutilation, PMC-E Population Media Center-Ethiopia

Bold indicates those variables associated at p-value <0.05

Qualitative findings also confirmed that the religious and deep-rooted myths underlying FGM remain persistent in the community. FGD and IDI participants noted that uncut girls face rejection, insults, and stigma, even from their own families. Some participants also remarked on perceived benefits of FGM in shaping girls’ sexual discipline and marriageability.

“Many times, people insult who did not undergo FGM… they insult by saying you eat the money of the child… by saying your child has waste, it is not disposed.”

(IDI, Esara, Father of an FGM and CM survivor )

“Circumcision refused family may be from neighbor and her peer may insult her. Sometime Circumcised girl may insult uncircumcised girl you are lumibutam (uncircumcised). But there is no much on circumcision. There is different view and insulting about circumcision” (Women’s FGD, Mareko )

"If she is not circumcised, no man will marry her. They say she is not clean; she is rebellious. That’s why even educated families still do it." (IDI, RLG)

CM

Overall, 83.4% of the exposed group demonstrated an unfavorable attitude toward CM, significantly higher than 78.1% in the non-exposed group (χ² = 11.25, p < 0.001). Significant differences were also observed across multiple key statements. Only 2.4% of the exposed group agreed that early marriage helps girls settle down, compared to 13.6% of the non-exposed group (χ² = 28.146, p < 0.001). Similarly, only 8.8% of the exposed group agreed that early marriage protects girls from dishonor, versus 13.6% in the non-exposed group (χ² = 24.962, p < 0.001). Regarding perceptions of the impact of early marriage on education, 90.7% of the exposed group agreed that marriage before age 18 ends a girl’s schooling, compared to 80.8% of the non-exposed group (χ² = 9.606, p = 0.048), suggesting stronger recognition of CM’s consequences for girls’ education. The exposed group also more strongly rejected economic, social, and autonomy-based justifications for CM and was more likely to support delaying marriage as a path to girls’ independence (Table 5).

Table 5.

Attitudes toward CM statements, PMC-E evaluation study, target districts, May 2025 (N = 403: exposed = 205, non-exposed = 198)

Attitudinal statement about CM	Response	Exposed (n = 205)	Non-exposed (n = 198)	χ²	p-value
Marrying a girl early protects her from premarital sex and dishonor.	Agree	18 (8.8%)	27 (13.6%)	24.962	< 0.001
	Disagree	187 (91.2%)	171 (86.4%)
Avoiding dishonor/premarital sex through early marriage is justifiable.	Agree	10 (4.9%)	28 (14.1%)	16.256	0.003
	Disagree	195 (95.1%)	170 (85.9%)
Early marriage eases the family’s economic burden.	Agree	6 (2.9%)	17 (8.6%)	9.398	0.024
	Disagree	199 (97.1%)	181 (91.4%)
Reducing economic burden through early marriage is fair.	Agree	6 (2.9%)	16 (8.1%)	11.016	0.012
	Disagree	199 (97.1%)	182 (91.9%)
Girls who marry early are better respected.	Agree	5 (2.4%)	15 (7.6%)	10.127	0.018
	Disagree	200 (97.6%)	183 (92.4%)
Gaining respect through early marriage is valuable.	Agree	7 (3.4%)	17 (8.6%)	13.483	0.009
	Disagree	198 (96.6%)	181 (91.4%)
Early marriage ensures girls settle down.	Agree	5 (2.4%)	27 (13.6%)	28.146	< 0.001
	Disagree	200 (97.6%)	171 (86.4%)
Settling down early for girls is valuable.	Agree	58 (28.3%)	68 (34.3%)	12.302	0.015
	Disagree	147 (71.7%)	130 (65.7%)
Early marriage exposes girls to pregnancy-related complications.* *	Agree	182 (88.8%)	152 (76.8%)	10.713	0.030
	Disagree	23 (11.2%)	46 (23.2%)
Facing complications through early marriage is justifiable. * *	Disagree	116 (56.6%)	103 (52.0%)	2.802	0.591
	Agree	89 (43.4%)	95 (48.0%)
Marriage before age 18 ends a girl’s schooling. ** *	Agree	186 (90.7%)	160 (80.8%)	9.606	0.048
	Disagree	19 (9.3%)	38 (19.2%)
Losing educational opportunity through early marriage is fair.**	Disagree	194 (94.6%)	182 (91.9%)	9.899	0.042
	Agree	11 (5.4%)	16 (8.1%)
Girls have no decision-making power in early marriages.**	Disagree	31 (15.1%)	41 (20.7%)	5.922	0.205
	Agree	174 (84.9%)	157 (79.3%)
Limiting a girl’s autonomy through CM is justifiable. * *	Disagree	182 (88.8%)	175 (88.4%)	7.085	0.131
	Agree	23 (11.2%)	23 (11.6%)
Delaying marriage helps girls achieve independence.* *	Agree	161 (78.5%)	134 (67.7%)	15.265	0.004
	Disagree	44 (21.5%)	64 (32.3%)
Gaining independence through delayed marriage is acceptable. * *	Agree	163 (79.5%)	135 (68.2%)	13.925	0.008
	Disagree	42 (20.5%)	63 (31.8%)
Overall attitude (opposed to CM)±		83.4%	78.1%	11.25	< 0.001

* * Anti-CM statement (response pattern varies; see note below)

^± Composite measure of overall attitude based on responses across all items

Statements marked with * * are anti-CM statements where the “favorable” response (indicating opposition to CM) varies depending on the question wording. For some, agreement indicates anti-CM attitude; for others, disagreement does

Abbreviations: CM Child marriage, PMC-E Population Media Center-Ethiopia

Bold indicates those variables associated at p-value <0.05

Practice and intention regarding FGM and CM

Practice of FGM and CM

The practice of FGM and CM was assessed both before and after project implementation. 855 girls/daughters were identified within the sampled households. Of these, 243 (28.4%) had ever been married, of which only 12 were married before the age of 18, indicating a CM prevalence of 4.9%. The overall prevalence of FGM among participants was 262 (32.7%), of which almost all (99.6%) had undergone the practice before the age of 18. However, no statistically significant differences in FGM or CM were observed between exposed and non-exposed groups (Table 6).

Table 6.

Prevalence of FGM and CM, PMC-E evaluation study May 2025 (N = 855: exposed = 442 and non-exposed = 413)

Variables		Non-exposed (n = 442)		Exposed (n = 413)		Total		Statistics
		Freq	%	Freq	%	Freq	%
Female children’s marital status	Married	122	29.5	121	27.4	243	28.4	χ² = 0.446, p = 0.494
	Unmarried	291	70.5	321	72.6	612	71.6
	Total	413	100	442	100	855	100
CM status (n = 243)	CM (married before 18)	7	5.7	5	4.1	12	4.9	χ² = 0.352, p = 0.553
	Legal age of marriage (18 or older)	115	94.3	116	95.9	231	95.1
	Total	122	100	121	100	243	100
FGM history (n = 654)*	Yes	107	36.0	117	32.8	224	34.3	χ² = 0.77, p = 0.380
	No	190	64.0	240	67.2	430	65.7
	Total	297	100	357	69.2	654	100
Prevalence of FGM at < 15 years old	Yes	107	100	116	99.1	223	99.6	±
	No	0	-	1	0.9	1	0.4
	Total	107	100	117	100	224	100

History of FGM	Prevalence timing	Non-exposed		Exposed		Total		Statistical Tests
PMC-E project life (2021–2025)	Prevalence in the last 5 years	10(10.3%) 9.3		11(10.6%) 9.4		21(9.4%)		χ² = 0.048, p = 0.827
FGM lifetime history (before intervention)	Prevalence before 5 years	97 (90.4%) 90.7		106 (89.4%) 90.6		203 (90.6%)
		107 (47.8%)		117 (52.2%)		224

* Missing data are present

±No assumptions fulfilled for association

Abbreviations: CM Child marriage, FGM Female genital mutilation, Freq Frequency, PMC-E Population Media Center-Ethiopia

Following the intervention FGM prevalence

Although no statistically significant differences were observed between two exposure groups, the data show a visible decline in FGM practice during the intervention period. Among 652 girls or daughters identified at risk from January 2020 to June 2025, only 21(3.22%) girls underwent FGM.

Qualitative findings revealed shifting practices of FGM and CM in the community, with some changes appearing positive and genuine, and others remaining superficial or symbolic. Participants described intergenerational dialogue in which increased awareness led families to spare younger generations from HPs.

“I was circumcised. And my older sisters were circumcised. But due to awareness… my younger sister has not be circumcised and also my children too.” (IDI, Mareko, Advocate).

Some participants noted that social sanctions are diminishing the practice. Community groups such as Idir have begun establishing regulations and punishments for those who perform FGM. However, enforcement of these locally established rules remains inconsistent.

“Our idir decided 10,000 ETB as punishment. Anyone who performs FGM will be excluded from social participation.” (FGD, Mareko, P6).

At the same time, participants reported that practices have shifted towards secrecy rather than abandonment. Qualitative data indicate that FGM is increasingly performed in secret in response to legal prohibitions, government penalties, and interventions such as PMC’s multimedia campaigns and public dialogues. Improved case reporting and law enforcement appear to have driven the practice underground rather than eliminating it.

“The community leaders send their daughters to rural areas where nobody checks. After a month, they return. It’s all done secretly now.“(Men’s, FGD, Esera).

“They do the cultural part, dancing, feeding, but the cutting happens later, somewhere else. The girl disappears for a few days and returns silently.” (IDI, Dasenech, radio listener group Member).

Reported intentions for FGM and CM

The study revealed clear differences in intentions regarding FGM and CM between exposed and non-exposed groups. Regarding FGM, only 0.5% of the exposed group were uncertain or willing to circumcise their daughters, compared to 4.1% in the non-exposed group (χ² = 9.42, p = 0.009). Similarly, only 1% of the exposed group would consider marrying off their daughters before age 18, compared to 6.6% in the non-exposed group (χ² = 9.14, p = 0.010).

The exposed group also reported significantly higher rates of taking preventive action against FGM (84.3% vs. 70.4%; χ² = 15.66, p = 0.004) and stronger commitment to resist early marriage pressure (94.1% vs. 85.3%; χ² = 11.72, p = 0.008) (Table 7).

Table 7.

Intention to prevent FGM and CM, PMC-E evaluation study, target districts, May 2025 (N = 403: exposed = 205, non-exposed = 198)

Item	Response	Non-exposed (n = 198)		Exposed n = 205		Statistics
FGM-related items		Freq	%	Freq	%
Expect daughter will not be circumcised	Disagree	20	10.4	22	11.0	χ² = 7.846, p = 0.097
	Agree	172	89.6	177	89.0
Resist FGM under pressure	Disagree	25	13.2	21	10.7	χ² = 8.337, p = 0.080
	Agree	165	86.8	175	89.3
Would refuse FGM invitation/request	Disagree	16	8.4	19	9.7	χ² = 10.902,p = 0.028
	Agree	174	91.6	177	90.3
Have taken steps to prevent FGM	Disagree	55	29.6	30	15.7	χ² = 15.663,p = 0.004
	Agree	131	70.4	161	84.3
Intend to circumcise daughter in the future	No	189	95.9	204	99.5	χ² = 9.417,p = 0.009
	Yes	8	4.1	1	0.5
CM-related items
Expect daughter will not marry before age 18	Disagree	22	11.2	8	3.9	χ² = 15.497,p = 0.004
	Agree	175	88.8	197	96.1
Resist early marriage pressure	Disagree	29	14.7	12	5.9	χ² = 11.719,p = 0.008
	Agree	168	85.3	193	94.1
Would reject early marriage proposals	Disagree	13	6.6	4	2.0	χ² = 9.682,p = 0.046
	Agree	184	93.4	201	98.0
Plan to delay daughter’s marriage	Disagree	20	10.2	8	3.9	χ² = 9.799,p = 0.020
	Agree	176	89.8	197	96.1
Intend to marry daughter off before age18	No	184	93.4	203	99.0	χ² = 9.141,p = 0.010
	Yes	13	6.6	2	1.0

“Not sure” responses were merged with “Agree” for pro-FGM/CM statements and with “Disagree” for anti-FGM/CM statements

Abbreviations: CM Child marriage, FGM Female genital mutilation, Freq Frequency, PMC-E Population Media Center-Ethiopia

Bold indicates those variables associated at p-value <0.05

Institutional support, legal enforcement, and challenges

According to qualitative findings, community-based structures such as Idir groups and kebele leadership are beginning to support legal enforcement against FGM and CM, though their involvement remains limited. Participants noted that policy responses are increasingly seen as critical, with swift action credited for preventing CM and rescuing at-risk girls.

“I told the police… they arrested him for 3 days… now police keep them… now thanks to God, it is peace.” (IDI, Esara, CM Survivor’s Father).

However, several challenges hinder the institutionalization and effective legal enforcement of anti-FGM and anti-CM efforts:

Community elders intervening in legal processes

Customary dispute resolution systems often undermine formal legal enforcement. Elders often remove cases from formal legal systems, resolving them according to traditional practices instead.

“There are elder (hafa shumagile) people… they ask court to hand over case to see at community level… based on their custom.” (IDI, Mareko, Advocate).

Victims claiming consent to avoid stigma

Girls often claim consent to marriage even when coerced, attempting to preserve their social standing and avoid further stigma.

“She may say ‘my life is once damaged’ and I don’t want enter issue’. She tries to accept marriage.” (IDI, Mareko, Advocate).

Discussion

The primary objective of this evaluation was to assess the association between a multimedia SBC intervention and changes in awareness, attitudes, norms, and practices related to FGM and CM. The study compared areas where PMC programming had been implemented to areas that did not receive the intervention. Consistent with established findings, the analysis showed statistically significant differences in knowledge and attitudes toward FGM and CM between exposed and non-exposed participants.

Participants exposed to the multimedia SBC intervention demonstrated significantly higher knowledge levels regarding FGM and CM, with 93.42% scoring high compared to 84.6% in the non-exposed group (p < 0.001), representing an 8.6% point difference. These findings are consistent with existing evidence. For instance, a study conducted in Ethiopia’s Oromia region found that individuals with access to more than 2 sources of information on FGM were 3 times more likely to possess adequate knowledge compared to those with 1 or no source [19]. Such results underscore the importance of diversified and sustained communication strategies in enhancing public awareness and shifting social norms.

Beyond HPs, exposure to health messaging through SBC interventions has been shown to significantly increase knowledge in other health domains. An Indian study found that participants exposed to SBC interventions were twice as likely to have better knowledge about menstrual health and hygiene [20]. Furthermore, findings from a UNICEF evaluation in Ethiopia reaffirm the pivotal role of media engagement, particularly radio talk show programs, in raising awareness of and shifting attitudes toward FGM and CM [16].

In contrast, studies conducted in rural communities of Enugu State, Nigeria, revealed that mass media engagement was ineffective in raising awareness and shifting behaviors related to FGM and CM [21]. This discrepancy might be explained by the study’s selection of remote rural sites with limited network and electricity access, where deeply rooted cultural values may have contributed to media ineffectiveness. Moreover, the Nigerian study lacked baseline data, audience segmentation research, and a comparison group, making it difficult to determine whether infrastructural constraints limited the intervention’s impact. The UNICEF evaluation shows that multimedia interventions succeed when they reach engaged audiences through multiple channels strategically chosen based on where the target audience actually obtains their information [16]. This consideration is essential for optimizing reach, resonance, and behavioral impact. In alignment with this approach, PMC consistently designs its multimedia SBC interventions based on FAR. This strategy is evident in the current post-project evaluation, which is consistent with the multimedia intervention’s potential to shift target audiences’ knowledge and attitudes toward FGM and CM.

Anti-FGM attitudes were higher among the exposed group (90.2%) compared to the non‑exposed group (81.4%), statistically significant difference (p = 0.014). Similarly, rejection of CM was greater among exposed participants (83.4%) than non‑exposed participants (78.1%), also a statistically significant difference (p < 0.001). These findings suggest a positive association between program exposure and more favorable attitudes toward abandonment of FGM and CM.

These findings align with studies from northern Nigeria, which found that storytelling and multimedia entertainment-education are critical approaches for shifting community attitudes toward early marriage [22]. According to UNICEF’s evaluation of radio talk show effectiveness, media engagement remains relevant for shifting attitudes toward FGM and CM [16]. PMC and UNICEF’s collaborative experience with other health issues further demonstrates the effectiveness of multimedia interventions; for example, their work on under-5 diarrheal disease in Ethiopia showed significant impact in shifting norms [23].

However, a study in Bangladesh using an edutainment approach did not show significant changes in community attitudes toward FGM and CM, although the study confirmed that behavioral experiments were less prone to social desirability bias in assessing sensitive topics [24]. The possible reason for the difference is that the investigators in Bangladesh focused on evaluating a single media intervention—a television series designed to promote positive role models—making it difficult to determine attribution in the presence of multiple media sources and variable exposure patterns.

In the present study, while quantitative findings demonstrated positive shifts in knowledge and attitudes toward FGM and CM, these findings uncovered persistent myths and misconceptions deeply rooted in intergenerational and sociocultural belief systems. Even though participants reported that most of the community is aware of FGM and CM, FGM is still associated with notions of marriageability, bodily cleanliness, and religious obligation. This justification is consistent with findings from studies conducted in Spain and the United Kingdom, where FGM was reported to be highly prevalent among immigrants who are residing there [25]. Similarly, in Ethiopia’s Afar and Somali regions, hygienic-esthetic and religious-spiritual factors were identified as major reasons for the continuation of the practice [26].

Surprisingly, across all study sites, a common belief held that FGM serves to calm girls and suppress perceived excessive sexual desire, reflecting entrenched sociocultural narratives that continue to justify the practice. Recognizing these narratives, KII participants emphasized the critical need for sustained community engagement strategies complemented by targeted multimedia awareness interventions to effectively challenge and transform harmful social norms.

Regarding CM, the survey results align with qualitative findings. More than three-quarter of participants agreed with some CM justifications, such as the claims that early marriage leads to pregnancy-related complications and ends schooling, or that delaying marriage helps achieve independence. However, the survey results contradicted qualitative findings on justifications related to family honor, the girl’s honor, and community acceptance. A majority of survey respondents disagreed with sociocultural and family honor justifications. This contradiction may be due to social desirability bias. Furthermore, qualitative studies often involve longer rapport-building, enabling more honest disclosure of taboo or stigmatized beliefs [27].

In the current study, the overall prevalence of FGM was 262/855 (32.7%), of which almost all (99.6%) had undergone the practice before the age of 18. Of the total women interviewed, 12 were married before the age of 18, indicating a CM prevalence of 4.9%. However, no significant differences in FGM and CM practice were observed between exposed and non-exposed groups (p = 0.38 and p = 0.55, respectively). The prevalence of FGM in this study was much lower than in other studies conducted in Ethiopia: EDHS 2016 reported 65% nationally, with nearly three-quarters (72%) in Afar region and 85% in Somali region having undergone FGM, and the pooled African prevalence was 56.4% [8, 28, 29]. Similarly, the reported practice of CM in this research is lower than in other Ethiopian studies: 33.7% in Harari region, 34.7% in Amhara region, and a pooled prevalence of 56.34% [30, 31, 32]. These differences could be due to the targeted behavioral intervention in the last 5 years, variations in when and where studies were conducted, and sociocultural differences across study sites.

Despite the notable decline in overall FGM prevalence, qualitative findings underscore the persistence of underground practices that evade legal accountability. Moreover, recent trends indicate a strategic shift in the timing and location of the procedure, with some communities increasingly conducting FGM during school holidays or when girls are temporarily out of school, thereby minimizing the risk of detection and legal repercussions.

Limitations

While this study utilizes a robust mixed-methods approach to compare exposed and unexposed populations, several limitations must be acknowledged. Since exposure was self-reported, some participants in the non-exposed group may have had incidental contact with intervention content without recognizing or recalling it; to the extent this occurred, it would tend to produce conservative estimates of the association between program exposure and outcomes. Although Chi-square tests indicated that sociodemographic characteristics were nearly identical across both groups, with p-values approaching 1.0 for key variables, the reliance on observational data means that unobserved endogeneity and selection bias cannot be entirely ruled out. While the use of unique, branded messaging like Yalaleke Guzo helped minimize recall bias among the unexposed group, the cross-sectional nature of the data primarily establishes associations rather than definitive causal links.

Conclusion

The multimedia SBC intervention was associated with increased awareness and more favorable attitudes toward FGM and CM, though no significant differences in practice were observed between exposed and non-exposed groups. The multimedia intervention was associated with shifts in intentions to commit HPs and with support for legal enforcement efforts. However, deeply rooted social norms related to misconceptions and myths about FGM and CM remained persistent, sustaining the practices. Moreover, entrenched cultural beliefs, religious misinterpretations, and traditional legal arbitration by elders continue to impede sustainable abandonment of FGM and CM. The role of male figures, teachers, religious leaders, and multi-sector stakeholders remains under-leveraged. Scaling community dialogues to involve all layers of the community, empowering youth, facilitating intergenerational dialogue, engaging men, empowering girls, coordinating stakeholders, and strengthening legal enforcement are critical for shifting social norms and accelerating the abandonment of FGM and CM in Ethiopia.

Abbreviations

CM

Child Marriage

EBC

Ethiopian Broadcasting Corporation

EDHS

Ethiopia Demographic Health Survey

FAR

Formative Audience Research

FGD

Focus Group Discussion

FGM

Female Genital Mutilation

HDA

Health Development Army

HEW

Health Extension Worker

HF

Health Facility

HH

Household

HP

Harmful Practice

IDI

In-Depth Interview

IRB

Institutional Review Board

IVR

Interactive Voice Response

KII

Key Informant Interview

PMC

Population Media Center

PMC-E

Population Media Center-Ethiopia

RLG

Radio Listener Group

SBC

Social and Behavior Change

SD

Standard Deviation

SDG

Sustainable Development Goal

UNFPA

United Nations Population Fund

UNICEF

United Nations Children’s Fund

WDA

Women’s Development Army

WHO

World Health Organization

WWSA

Woreda Women and Social Affairs Office

Authors’ contributions

KM: Conceptualization, methodology, reviewing and editing, supervision of data collection, quality assurance, and manuscript writing. MEA: Conceptualization, methodology, reviewing and editing, and quality control. YK: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, visualization, and writing—original draft. KA: Reviewing, project administration, and management. SZ: Reviewing, project administration, and supervision. AM: Reviewing the manuscript, editing, and quality assurance. AA: support in revising the manuscript, support in conceptualization of research idea ST: Supporting manuscript writing, report editing, and reviewing. BF: Reviewing and editing. BJ: Reviewing and editing. HE: Reviewing, methodology, and supervision. AHR: Conceptualization, methodology, reviewing, finalizing, and quality control.

Funding

This research was financially supported by PMC through a grant provided by UNFPA. The study was implemented by an independent consulting firm contracted for data collection and analysis.

Data availability

The data sets generated and/or analyzed during the current study are available from PMC-E upon reasonable request.

Declarations

Ethics approval and consent to participate

The study was reviewed and ethically approved by the Institute of Health, Jimma University, with reference number JUIH/IRB/0492/25. Informed consent was obtained from every respondent. Data were collected in a private manner. Confidentiality of the data was maintained through the use of pseudonyms during interviews, and all identifiers were removed from transcriptions and reporting.

Consent for publication

All participants provided consent for publication of anonymized data and findings delivered from this study.

Competing interests

The authors declare no competing interests.