Female genital mutilation: prevalence and factors associated with its type among women of reproductive age group in Somaliland: further analysis of 2020 Demographic and Health Survey Data

Abstract

BACKGROUND: Female genital mutilation is a major public health and human rights concern, with the highest burden reported in countries of the Horn of Africa. Despite long-standing legal bans and prevention efforts, the practice remains nearly universal in Somaliland, driven by deeply rooted social and cultural norms. Evidence on the prevalence, types, and population-level determinants of female genital mutilation in Somaliland remains limited. This study assessed the prevalence, types, and associated factors of female genital mutilation among women of reproductive age in Somaliland. METHODS: This population-based study analyzed data from 5,143 women aged 15-49 years who participated in the 2020 Somaliland Demographic and Health Survey. A two-stage cluster sampling design was used, involving the selection of enumeration areas followed by households. Descriptive analyses were conducted to estimate prevalence and types of female genital mutilation. Binary logistic regression was used to identify factors associated with the pharaonic type of female genital mutilation in comparison with other types. RESULTS: The overall prevalence of female genital mutilation was 99.49% (95% confidence interval: 99.30-99.70). The most common form was type three (pharaonic), affecting 66.97% of women, followed by type one (sunni) at 22.01% and type two (intermediate) at 9.50%. Women from nomadic communities, those with no formal education, those in lower wealth households, women who had never used the internet, and those circumcised by traditional practitioners had significantly higher odds of experiencing the pharaonic form of female genital mutilation. CONCLUSIONS: Female genital mutilation remains nearly universal among women of reproductive age in Somaliland, with severe forms predominating. Social disadvantage, limited access to education and information, and reliance on traditional circumcisers are key population-level drivers of harmful practices. Interventions that expand educational and digital access and engage traditional practitioners may be critical to reducing the persistence and severity of female genital mutilation in Somaliland.