Scale up of female genital mutilation prevention and care in primary care settings in Guinea and Kenya: a quasi-experimental, pre versus post test study

Between 2020 and 2021, a health system strengthening intervention involving person-centred communication (PCC) for prevention of female genital mutilation (FGM) was tested in Guinea, Kenya, and Somalia. The study found that health workers at intervention sites had better knowledge and communication skills regarding FGM prevention and their antenatal care (ANC) clients were more likely to be opposed to FGM and to not intend to subject their daughters to FGM as compared to control group. The current study aims to assess the impact of this evidence-based intervention when brought to scale. This quasi-experimental study will use a pre- and post-test design, targeting health workers from facilities that did not receive the intervention in the previous study. Health workers at study sites will receive the intervention package either during a centralized training or by trained colleagues. Unique clients exiting ANC and childhood immunization services will be interviewed at three time points (0, 3 and 9 months) using standardized questionnaires developed for this study. Outcomes include health workers’ FGM-related knowledge, attitudes, and practices, and the FGM intentions of their clients. Barriers and facilitators to scale up will be assessed as well as feasibility, costs, fidelity and reach of the intervention. Generalized estimating equations (GEE) will be used to assess changes in outcomes over time with multilevel mixed-effect models to account for clustering at the facility level. Thematic analysis will be used to analyze qualitative data. This research contributes knowledge on how the health sector can contribute to FGM abandonment efforts and how health workers can be supported to be opinion leaders in shaping social norms. The findings contribute to Guinea and Kenya realizing obligations towards international human rights conventions, global goals on FGM abandonment, and improved health and well-being of women and girls. The study was registered retrospectively with ISRCTN (ISRCTN14451139) on 02 September 2025.