Attitudes towards the practice of female genital mutilation/cutting in Somaliland: evidence from the Somali Demographic Health Survey 2020.

Abstract

Objectives: To identify key demographic, socio-economic, and cultural determinants influencing the continuation of FGM/C and to evaluate its prevalence and associated factors utilizing the 2020 Somali Demographic and Health Survey (SDHS).

Methodology: A secondary analysis of the Somali Demographic Health Survey (SDHS) in 2020 was conducted, utilizing responses from 6,580 mothers of female children aged 0-14 years. Descriptive statistics, chi-square tests, and multi-nominal logistic regression were employed to analyze the prevalence and associated factors of FGM/C. The analysis incorporated sampling weights to ensure accurate population representation.

Results: The prevalence of FGM/C among respondents was 99.6% (n = 6,553), with Pharaonic circumcision being the most prevalent type (76.7%), followed by Sunni (14.1%) and intermediate forms (8.8%). Demographically, 83.9% of respondents had no formal education, while only 0.99% attained higher education, and the majority resided in nomadic (37.7%) and rural (33.6%) areas. Regional variations were observed, with the highest support for FGM/C continuation in Sanaag (77.2%) and the lowest in Maroodi-jeeh (42.2%). Chi-square analysis revealed significant associations between attitudes toward FGM/C and age (X² = 57.12, p < 0.001), place of residence (X² = 299.45, p < 0.001), education (X² = 140.09, p < 0.001), and wealth (X² = 67.48, p < 0.001). Women in nomadic areas (76.1%) and those with no education (67.6%) were more likely to support continuation, compared to urban residents (53.5%) and those with higher education (24.6%). Multinomial logistic regression indicated that urban residents were 44.7% less likely to support continuation than nomadic residents (Exp(B) = 0.553, p < 0.001), and women with no formal education were 2.3 times more likely to support continuation than those with higher education (Exp(B) = 2.307, p = 0.025). Religious beliefs strongly influenced attitudes, with those considering FGM/C a religious requirement overwhelmingly supporting its continuation (Exp(B) ≈ 0, p < 0.001).

Conclusion: Notwithstanding the near-universal prevalence of FGM/C in Somaliland, attitudes toward its perpetuation are influenced by educational attainment, socioeconomic status, geographical location, and religious convictions. Targeted educational initiatives and culturally appropriate interventions are imperative for altering perceptions and mitigating the practice.