Nearly 173,000 Older Women in Europe Are Living With Female Genital Mutilation, New Estimates Reveal

European health systems have long framed female genital mutilation or cutting, known as FGM/C, as a problem of girls and women of reproductive age. Prevention programs target daughters at risk, maternity services manage obstetric complications, and clinical guidelines concentrate on sexual and reproductive health. A new demographic analysis published in The Lancet Regional Health – Europe now shows that this framing has quietly become outdated. According to census-based indirect estimates covering the EU-27, Norway, Switzerland, and Iceland, an estimated 172,813 women aged 50 years or older were living with FGM/C in 2021, representing 29.5 percent of all women aged 15 and older in the region estimated to be affected. The finding reveals a substantial and growing population that has largely been invisible to researchers, policymakers, and clinicians alike.

The estimates were produced by Livia Elisa Ortensi using an enhanced indirect estimation approach applied to the 2021 census round. Because neither European censuses nor routine health registers record FGM/C status, researchers must combine information on the country of birth of migrant women with age-specific prevalence data from FGM/C-practicing countries of origin, drawn primarily from Demographic and Health Surveys and Multiple Indicator Cluster Surveys conducted between 2004 and 2022. The method accounts for cohort effects, the fact that older generations in practicing countries were more likely to have undergone the procedure, and for migrant selectivity, the possibility that migrants differ from the general population of their origin countries. The resulting figures should be read as statistically modeled estimates rather than exact case counts, but they provide the most comprehensive picture to date of the older dimension of FGM/C in Europe, updating the benchmark estimates produced by Van Baelen and colleagues nearly a decade ago.

The headline numbers conceal striking variation across the continent. France hosts the largest estimated population of older women living with FGM/C, with 38,566 women aged 50 and above, followed by the Netherlands with 32,737, Italy with 26,073, and Germany with 19,229. Prevalence among women born in FGM/C-practicing countries rises steeply with age, from 41.3 percent among those aged 50 to 64, to 49.1 percent among those aged 65 to 74, and 58.7 percent among those aged 75 and older, a pattern consistent with cohort effects in countries of origin where the practice has declined over successive generations. In Greece, estimated prevalence among older migrant women reaches 81.4 percent, and in Poland 80.5 percent, reflecting the specific origins of their migrant communities, dominated by women born in Egypt and other countries where historical prevalence was near universal.

Perhaps the most consequential finding concerns the demographic weight of the older population. In Greece, Croatia, Poland, and the Netherlands, women aged 50 or older account for more than half of all women aged 15 and older estimated to be living with FGM/C. In the Netherlands, where the largest group of older affected women originates from Indonesia, the figure stands at 50.6 percent. This is not a marginal population approaching the end of its demographic life; it is a structural feature of Europe’s aging migrant communities. The leading countries of origin across the region as a whole are Indonesia, accounting for 17.2 percent of older women estimated to be living with FGM/C, Egypt with 15.7 percent, and Somalia with 9.8 percent, a composition that varies sharply from one destination country to another and carries direct implications for how services should be tailored.

Why does this matter clinically? As women with FGM/C move beyond their reproductive years, they tend to disappear from research agendas, clinical guidelines, and health policy, precisely at the point where new health needs may emerge. Menopause brings hormonal changes that interact with the scarring, altered anatomy, and tissue damage caused by FGM/C. Evidence suggests these interactions may worsen vaginal dryness, intensify genitourinary syndrome of menopause, and increase susceptibility to infection. The physiological reasoning is straightforward: declining estrogen already thins and reduces the elasticity of genital tissue, and in women with extensive scarring or infibulation, these changes can compound existing structural damage, chronic pain, and urinary or menstrual complications that were never surgically addressed.

The psychological dimension is equally underexplored. Little is known about how depression, anxiety, and post-traumatic stress related to FGM/C evolve with age, even though trauma-related conditions may persist or resurface decades after the original procedure. Compounding the problem, older women may normalize FGM/C-related genital symptoms as an expected part of aging, delaying help-seeking or disclosure to clinicians who themselves may not ask. Access to care is further 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, expressed, and interpreted by both patients and providers.

The study also exposes a structural gap in European data infrastructure. Because the United Kingdom has left the European Union, Eurostat no longer receives harmonized population data from the UK Office for National Statistics, making comparable estimates for the UK impossible within this framework. For the countries covered, the analysis demonstrates that census-based indirect estimation can be systematically repeated as new census rounds become available, allowing health planners to track how the population ages and where needs will concentrate. The method’s reliance on origin-country survey data also means estimates inherit the limitations of those surveys, including recall issues and coverage of only nationally representative samples, which the underlying study discusses in detail.

The policy implications are clear and, the author argues, urgent. The number of older women living with FGM/C is likely to increase further as migrant communities age in the coming decades. Research funding should prioritize the clinical and social implications of aging with FGM/C, a field that remains strikingly thin. Future studies should routinely include women beyond reproductive age rather than capping samples at 49 years. Clinical guidance should explicitly address older women, and the services they already use, including geriatric medicine, primary care, gynecology, urology, and mental health services, should be equipped to recognize and respond to the specific needs of women living with FGM/C. Training curricula and awareness materials aimed at health professionals should extend beyond maternity care to the full life course.

Ultimately, the analysis reframes FGM/C in Europe as an aging and diversity issue, not solely a child protection or reproductive health issue. Recognizing the presence of nearly 173,000 older women living with the consequences of FGM/C is presented as an essential precondition for European health systems to respond equitably to the aging of their increasingly diverse populations. As the demographic transition documented in this study continues, the choice for policymakers is between planning for a visible, quantified population with documented needs, or continuing to allow tens of thousands of older women to remain statistically and clinically invisible.

Subject of Research: Estimating the population of older women living with female genital mutilation/cutting in Europe and its implications for health policy and research

Article Title: Making older women with female genital mutilation visible: new estimates for the EU-27, Norway, Switzerland, and Iceland and implications for health policy and research

Article References: Making older women with female genital mutilation visible: new estimates for the EU-27, Norway, Switzerland, and Iceland and implications for health policy and research. (n.d.). https://doi.org/10.1016/j.lanepe.2026.101867

Image Credits: AI Generated

DOI: 10.1016/j.lanepe.2026.101867

Keywords: female genital mutilation, FGM/C, older women, migrant health, Europe, demographic estimates, census data, menopause, health policy, aging migrant populations, The Lancet Regional Health Europe, women's health