European policies, research, and care practices addressing female genital mutilation/cutting (FGM/C)—the partial or total removal or alteration of the external female genitalia for non-medical reasons—have predominantly centered on prevention and protection of girls at risk and on managing health complications, particularly those related to sexual, reproductive, and obstetric health.1 Yet recently published census-based indirect estimates for the EU-27, Norway, Switzerland, and Iceland2 (EU+) reveal an important demographic shift: the aging of migrant populations has led to the emergence of a substantial population living with FGM/C beyond reproductive age. These estimates, which should not be interpreted as exact case counts, were derived using an enhanced indirect estimation approach that accounts for cohort effects and migrant selectivity. The underlying study revisits and updates the benchmark estimates produced by Van Baelen and colleagues3 and provides full methodological details and a discussion of the main limitations,2 including the lack of comparable estimates for the United Kingdom because, following its withdrawal from the European Union, Eurostat no longer receives harmonized population data from the UK Office for National Statistics (Table 1).
Table 1.
Estimated number of women living with female genital mutilation/cutting (N FGM/C) and FGM/C prevalence (% FGM/C) among women from FGM/C-practicing countries in the EU-27, Norway, Switzerland, and Iceland, by age group and main countries of origin.
| Country | 50–64 |
65–74 |
75+ |
Total 50+ |
Women aged ≥50 as % of all women aged ≥15 from FGM/C-practicing countries | Women aged ≥50 as % of all women aged ≥15 estimated to be living with FGM/C | Leading countries of origin among women aged ≥50 estimated to be living with FGM/C |
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N with FGM/C | % FGM/C | N with FGM/C | % FGM/C | N with FGM/C | % FGM/C | N | N with FGM/C | % FGM/C | 1st country | % country 1 | 2nd country | % country 2 | 3rd country | % country 3 | |||
| Austria | 2099 | 55.9 | 441 | 59.0 | 186 | 63.3 | 4798 | 2726 | 56.8 | 21.7 | 24.6 | Egypt | 56.4 | Nigeria | 12.0 | Iraq | 10.4 |
| Belgium | 2272 | 32.6 | 588 | 42.1 | 335 | 49.1 | 9043 | 3195 | 35.3 | 14.5 | 14.6 | Indonesia | 14.5 | Somalia | 12.6 | Guinea | 11.1 |
| Bulgaria | <15 | 31.8 | <10 | 66.7 | <5 | 42.9 | 60 | 23 | 38.3 | 14.8 | 18.0 | ||||||
| Croatia | 18 | 52.9 | <10 | 61.5 | 72 | 91.1 | 126 | 98 | 77.8 | 44.1 | 61.6 | Egypt | 79.6 | Guinea | 9.2 | Ethiopia | 3.1 |
| Cyprus | 152 | 54.3 | 166 | 73.1 | 224 | 90.3 | 755 | 542 | 71.8 | 31.7 | 46.3 | Egypt | 73.1 | Sudan | 10.3 | Iraq | 4.6 |
| Czech Republic | 51 | 37.8 | 15 | 53.6 | <10 | 45.0 | 183 | 75 | 41.0 | 15.6 | 18.9 | Egypt | 25.3 | Iraq | 25.3 | Ethiopia | 10.7 |
| Denmark | 2528 | 44.0 | 465 | 46.9 | 293 | 59.1 | 7236 | 3286 | 45.4 | 29.0 | 31.1 | Somalia | 46.4 | Iraq | 24.3 | Egypt | 6.7 |
| Estonia | <5 | – | <5 | – | <5 | – | 7 | <10 | 71.4 | 1.3 | 2.7 | – | – | – | – | – | – |
| Finland | 1147 | 55.5 | 211 | 64.1 | 96 | 66.2 | 2542 | 1454 | 57.2 | 14.3 | 16.8 | Somalia | 63.6 | Iraq | 16.9 | Ethiopia | 5.2 |
| France | 26,491 | 34.1 | 7734 | 37.0 | 4341 | 47.0 | 107,897 | 38,566 | 35.7 | 29.0 | 31.1 | Mali | 23.6 | Senegal | 15.3 | Guinea | 13.8 |
| Germany | 13,414 | 35.4 | 3933 | 45.3 | 1882 | 55.4 | 49,980 | 19,229 | 38.5 | 20.0 | 23.4 | Iraq | 20.4 | Eritrea | 19.0 | Indonesia | 11.4 |
| Greece | 2384 | 70.4 | 2978 | 83.1 | 3096 | 90.4 | 10,396 | 8458 | 81.4 | 60.6 | 70.9 | Egypt | 82.2 | Ethiopia | 5.9 | Sudan | 5.7 |
| Hungary | 120 | 51.5 | 43 | 57.3 | 20 | 55.6 | 344 | 183 | 53.2 | 14.5 | 20.6 | Egypt | 47.0 | Iraq | 12.6 | Burkina Faso | 10.9 |
| Ireland | 2258 | 63.5 | 195 | 65.0 | 102 | 64.2 | 4017 | 2555 | 63.6 | 21.9 | 27.7 | Nigeria | 73.0 | Somalia | 7.0 | Sudan | 5.0 |
| Italy | 14,163 | 50.2 | 5518 | 68.9 | 6392 | 81.1 | 44,125 | 26,073 | 59.1 | 24.7 | 31.6 | Egypt | 26.9 | Ethiopia | 24.5 | Nigeria | 17.3 |
| Latvia | <5 | – | <5 | – | <5 | – | 5 | <5 | 40.0 | 7.7 | 14.3 | – | – | – | – | – | – |
| Lithuania | 0 | – | 0 | – | 0 | – | 0 | 0 | – | 0.0 | 0.0 | – | – | – | – | – | – |
| Luxembourg | 167 | 29.8 | 40 | 36.4 | 19 | 44.2 | 713 | 226 | 31.7 | 15.7 | 15.1 | Guinea-Bissau | 22.1 | Egypt | 18.6 | Guinea | 11.1 |
| Malta | 51 | 57.3 | 23 | 60.5 | 38 | 84.4 | 172 | 112 | 65.1 | 13.1 | 15.5 | Egypt | 62.5 | Nigeria | 16.1 | Kenya | 3.6 |
| Netherlands | 11,533 | 44.1 | 11,591 | 48.4 | 9613 | 49.1 | 69,700 | 32,737 | 47.0 | 51.1 | 50.6 | Indonesia | 75.5 | Somalia | 6.6 | Iraq | 5.1 |
| Poland | 188 | 70.7 | 173 | 81.2 | 306 | 87.4 | 829 | 667 | 80.5 | 38.6 | 59.9 | Egypt | 90.1 | Iraq | 2.1 | Nigeria | 1.5 |
| Portugal | 1232 | 35.9 | 352 | 37.5 | 161 | 35.4 | 4830 | 1745 | 36.1 | 31.9 | 31.8 | Guinea-Bissau | 69.3 | Guinea | 19.8 | Egypt | 1.9 |
| Romania | 40 | 33.6 | <10 | 38.5 | <10 | 50.0 | 142 | 50 | 35.2 | 20.9 | 21.7 | Egypt | 48.0 | Iraq | 48.0 | Yemen | 6.0 |
| Slovakia | <10 | 29.4 | <5 | 33.3 | <5 | 66.7 | 26 | <10 | 34.6 | 19.4 | 18.0 | – | – | – | – | – | – |
| Slovenia | <15 | 41.7 | <10 | 71.4 | <10 | 77.8 | 40 | 22 | 55.0 | 19.4 | 25.0 | – | – | – | – | – | – |
| Spain | 3225 | 46.5 | 742 | 55.6 | 398 | 67.6 | 8856 | 4365 | 49.3 | 14.8 | 17.5 | Guinea | 28.8 | Nigeria | 16.1 | Senegal | 10.8 |
| Sweden | 12,375 | 46.2 | 2947 | 48.8 | 1773 | 58.4 | 35,865 | 17,095 | 47.7 | 23.5 | 23.4 | Somalia | 31.4 | Iraq | 29.1 | Eritrea | 16.8 |
| Total EU | 95,941 | 40.9 | 38,183 | 49.0 | 29,374 | 58.5 | 362,687 | 163,498 | 45.1 | 27.0 | 30.4 | Indonesia | 17.8 | Egypt | 15.9 | Somalia | 8.8 |
| Switzerland | 3161 | 39.7 | 1020 | 49.4 | 670 | 64.9 | 11,067 | 4851 | 43.8 | 23.4 | 22.4 | Egypt | 23.2 | Eritrea | 16.0 | Somalia | 12.0 |
| Norway | 3593 | 57.4 | 552 | 59.9 | 295 | 72.8 | 7583 | 4440 | 58.6 | 16.8 | 16.8 | Somalia | 44.8 | Eritrea | 21.5 | Iraq | 11.7 |
| Iceland | 19 | 38.0 | <10 | 45.5 | 0 | 0.0 | 65 | 24 | 36.9 | 10.4 | 12.2 | – | – | – | – | – | – |
| Total EU+ | 102,714 | 41.3 | 39,760 | 49.1 | 30,339 | 58.7 | 381,402 | 172,813 | 45.3 | 26.6 | 29.5 | Indonesia | 17.2 | Egypt | 15.7 | Somalia | 9.8 |
Note: FGM/C prevalence is calculated among women born in FGM/C-practicing countries. Estimated FGM/C counts below 15 are reported using small-count thresholds (<5 for values 1–4, <10 for values 5–9, and <15 for values 10–14); zero counts are reported as 0. Countries of origin are reported only for destination countries with at least 50 estimated women aged 50 years or older living with FGM/C. Only the three leading countries of origin are shown. Country-of-origin prevalence inputs were derived from the most recent nationally representative surveys available around the 2021 census (primarily Demographic and Health Surveys and Multiple Indicator Cluster Surveys; survey years 2004–2022) and were aligned to the 2021 reference year using the cohort-component procedure described in [2].
Source: Author’s elaboration based on [2].
In 2021, an estimated 172,813 women aged 50 years or older were living with FGM/C in the region, accounting for 29.5% of all affected women aged 15 years and older. Estimated FGM/C prevalence was higher in older age groups, rising from 41.3% among women aged 50–64 years to 49.1% among those aged 65–74 years and 58.7% among those aged 75 years and older, consistent with cohort effects in countries of origin. The distribution varies considerably across the study area. France, the Netherlands, Italy, and Germany host the largest estimated numbers, while Greece and Poland have particularly high estimated FGM/C prevalence. In Greece, Croatia, Poland, and the Netherlands, women aged 50 years or older constitute more than half of all women aged 15 years or older estimated to be living with FGM/C, underscoring the structural rather than marginal nature of this demographic transition.
As women with FGM/C move beyond their reproductive years, they tend to disappear from research, clinical guidelines, and health policy. However, menopausal changes may interact with scarring, altered anatomy, and other consequences of FGM/C, potentially worsening vaginal dryness, genitourinary syndrome of menopause, and susceptibility to infection.4,5 Psychological consequences may also persist in later life: little is known about how depression, anxiety, and post-traumatic stress related to FGM/C evolve with age.6 Also, older women may normalize FGM/C-related genital symptoms as part of aging, potentially delaying help-seeking or disclosure.7 Access to care may also be constrained by intersecting barriers related to age, gender, migration status, language, culture, and socioeconomic disadvantage, including differences in how pain and menopause-related symptoms are understood and expressed.
By quantifying older women living with FGM/C, our analysis highlights a growing mismatch between demographic reality and current health policy. The number of older women living with FGM/C is likely to increase further as migrant communities age, underscoring the need for research and funding on the clinical and social implications of aging with FGM/C. Future research should routinely include women beyond reproductive age, and clinical guidance should explicitly address older women. Services routinely used by older adults—including geriatric, primary, gynecological, urological, and mental health services—should more explicitly address the care needs of women living with FGM/C. Recognizing the presence of this population is essential for European health systems to respond equitably to the aging of their increasingly diverse populations.
Contributors
LEO is the only author, she conceived the Correspondence, conducted the analysis, interpreted the findings, and drafted and revised the manuscript. She had full access to the data and takes responsibility for the decision to submit the manuscript for publication.
Declaration of interests
I declare no competing interests.
Acknowledgements
Generative artificial intelligence (ChatGPT, OpenAI) was used to assist with language editing. The author reviewed and revised all AI-assisted text and takes full responsibility for the final content.
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