20% of women and girls in Nigeria have undergone female genital cutting (FGC). Although FGC may have cultural and religious importance, it is a violation of human rights and is associated with long-term impacts on women’s health. FGC is practiced to ensure marriage eligibility and attenuate sexual desires, but intercourse can be painful for women with FGC, and while there appears to be a relationship between FGC and STIs and infertility, these pathways are not clear. Therefore, this dissertation utilized Nigeria Demographic and Health Survey (NDHS) data to accomplish the following three aims: 1) Examine trends in women’s attitudes and beliefs toward FGC from 2003-2018 in Nigeria, including after criminalization of FGC in 2015, and by region; 2) Assess the association between FGC and sexual behaviors among couples; and 3) Examine the relationship between FGC and delays in pregnancy via time-to-pregnancy (TTP).

The first study found women’s attitudes and religious beliefs toward FGC have changed in Nigeria, with support and religious beliefs toward FGC decreasing in the South, but increasing in the North. These variations may reflect concerted efforts to address FGC through state-level policies and anti-FGC programs in the southern regions where it is more commonly practiced, while the northern regions have experienced ongoing conflicts. The second study found women with FGC are less likely to have been recently sexually active, more likely to be sexually active before age 18, their partners are more likely to have had extramarital sexual partners in the past year, and the magnitude of these associations is greater for women with more severe forms of FGC. The third study found more severe forms of FGC may lead to longer TTP among nulliparous women, but the relationship between FGC and increased TTP was not evident among parous women. However, these associations may be complicated by differences in fertility preferences and sexual behaviors. As we move forward in efforts to prioritize the sexual and reproductive health and rights of women and girls across the globe, examining the impact that cultural practices, like FGC, can have on health behaviors is a critical area of research.