Female genital mutilation: Current practices and perceptions in Somaliland

Background: Somaliland, Africa has the highest prevalence of female genital mutilation (FGM) in the world despite its recognition as a human rights violation and decades of campaigns to eliminate it. This study established baseline data for FGM prevalence in Somaliland and explored changing perceptions of FGM among Somalis. Methods:  A descriptive study was conducted among 6,108 women at the Edna Adan University Hospital (EAUH) from 2006-2013. Data were obtained regarding FGM status and knowledge and perception towards the practice. Chi-square analysis was conducted to compare current and previous studies conducted at EAUH. Results:  The prevalence rate of FGM among respondents was 98.4% and procedures took place at an average age of 8.47 years.  Most participants (82.20%) underwent the most severe Type III or Pharaonic FGM. The most commonly cited reasons for practicing FGM were to maintain cultural and traditional values (82.9%).  Continuation of the practice was supported among 83.17% of respondents, the majority of whom reported a preference for the milder Type I or II Sunna FGM (95.15%). Women who attended university were subjected to FGM less than their uneducated counterparts, and younger women reported a higher prevalence of the milder Sunna FGM. Comparison of the current and previous studies revealed a shift toward the less invasive Sunna type FGM (χ²=16.81, p=0.0).  Conclusions:  Prevalence of FGM remains high in Somaliland, suggesting that advocacy to abandon the act has been unsuccessful. Pharaonic FGM currently predominates; however, comparison with previous baseline data indicates a trend toward the milder Sunna type FGM.