Background: Though convicted and considered as a crime by the countries government, Female Genital Mutilation (FGM) remains a common public health problem in Africa and Ethiopia as well. Every year, more than 3 million females undergo FGM and most of them are in Africa. Thus, this study was aimed at modeling the spatial pattern and determinant factors of female genital mutilation in rural Ethiopia using spatial and multilevel analysis based on the Ethiopian demographic and Health Survey 2016 data. Method: This is a secondary data analysis of the Ethiopian Demographic and Health survey that collected women aged 15-49 years out of which 14,552 women were considered in this study. The data were found to have excess zeros (74.42%) and the variance was higher than its mean. The LRT test suggested that the number of circumcised daughters varies among clusters and the multilevel count model fits better than the single level count model. The data were weighted using sampling weight as recommended by the program. The STATA version 14, GeoDa, and ArcGIS 10.4 software were used for data cleaning and spatial analysis respectively. Global and local level clustering was assessed. For the none spatial data and the determinant factors, data cleaning and analysis were done using R version 4.1. Since the data has significant clustering with the Intraclass Correlation Coefficient [ICC=0.45] a spatial auto covariate generalized multi-level mixed ZIP regression model was fitted. Variables with a P-value<0.05 with a 95% CI of odds ratio were reported as statistical determinants of FGM. Results: FGM was spatial clustered (Global Moran’s I=0.41, p<.001). Significant hotspot clusters were found in Afar, eastern Amhara, Benishangul gumuz, Somali, Hareri, and Dire Dawa. Female household head( exp(-0.114)=0.89, 95% CI=0.8, 0.97), occupation status of mother(others=unskilled manual, electrician …(exp(-0.419)=0.66, 95% CI: 0.49, 0.87)), Muslim religious(exp(0.257)=1.29, 95% CI: 1.04, 2.85), Afar(exp(2.450)= 11.5, 95% CI: 4.54, 29.57), Amhara(exp(1.705)=5.5, 95%CI:2.29, 13.21), Somali(exp(1.835)=6.26, 95% CI: 2.31, 16.95), Benishangul gumuz(exp(0.193)=1.2, 95% CI: 1.049, 1.402), SNNP(exp(0.219)=1.24, 95%CI: 1.054, 1.470) regions, and Hareri(exp(2.192)=8.9, 95%CI: 2.912, 27.525). Traditional circumcisers (exp (2.306) =10.03, 95% CI: 1.35, 74.37) were found to be significant determinants of female genital mutilation. The study also shows that there is a significant cluster variation of circumcised daughters (= 2.49, and = 0.832). Whereas the education status of the mother and age of the mother is varying across clusters. Conclusion: Female genital mutilation was spatially clustered with hotspot areas found: in Afar, eastern Amhara, Benishangul gumuz, Somali, regions, Dire-Da’wa, and Harari administrative. The sex of household head, religion, occupation, information about Female genital mutilation, auto covariate, and FGM required by religion were significant determinants of female genital mutilation. ➢ Recommendation Policy makers should include FGM preventive mechanisms, healthy institutions like midwifery also provide awareness for parents of daughters. ➢ Religious institutions should create awareness for the community concerning FGM ➢ Communities like local elders should give awareness to traditional circumcisers