Have we made progress in Somalia after 30 years of interventions? Attitudes toward female circumcision among people in the Hargeisa district

Abstract

BackgroundFemale circumcision is a major public health problem that largely contributes to the ill-health of women and their children globally. Accordingly, the international community is committed to take all possible measures to abolish the practice that is internationally considered to be absolutely intolerable. While the practice is a social tradition shared by people in 28 African countries, there is no country on earth where FC is more prevalent than in Somalia. Yet, since the early 1990s, there is no quantitative study that has investigated whether the perception towards the practice among Somali men and women in Somalia has improved or not. Thus, this cross-sectional quantitative study examines the attitudes toward the practice among people in Hargeisa, Somalia.MethodsA cross-sectional study of 215 randomly selected persons, including both men and women, was conducted in Hargeisa, Somalia from July to September of 2011. Participants were interviewed using structured questionnaires, with questions including the circumcision status of the female participants, the type of circumcision, if one has the intention to circumcise his/her daughter, whether one supports the continuation or discontinuation of the practice and men’s perceptions toward having an uncircumcised woman as a wife.ResultThe findings show that 97% of the study’s participants were circumcised with no age differences. Of this, 81% were subjected to Type 3, while 16% were subjected to either Type 1 or 2 and only 3% were left uncircumcised. Approximately 85% of the respondents had intention to circumcise their daughters, with 13% were planning the most radical form. Among men, 96% preferred to marry circumcised women, whereas overall, 90% of respondents supported the continuation of the practice. The vast majority of the study’s respondents had a good knowledge of the negative health effects of female circumcision. In multivariate logistic regressions, with an adjustment for all other important variables, female circumcision (the Sunna form) is a religious requirement 16.5 (2.43-112.6) and the Sunna form is not harmful 25.1(2.35-281.1), are the two factors significantly associated with the continuation of female circumcision. Moreover, females were less likely to support the continuation of FC compared to their male counterparts (aOR 0.07; CI: 0.05-0.88).ConclusionThe study shows that the support towards the persistence of the practice is profoundly high in Somalia. People are aware of the health and human rights effect of female circumcision, and yet they support the continuation of the practice. Therefore, over 30 years of campaigns with limited progress demand an alternative approach towards the eradication of female circumcision in Somalia.

Attitude towards the Practice of Female Genital Cutting among School Boys and Girls in Somali and Harari Regions, Eastern Ethiopia

“…Another study stated that, in communities where FGC is normative, women view the practice as an important aspect of their life [26]. In contrast to this, the study done in Somalia reveals that male respondents (96%) supported the continuation of FGC and they largely preferred to marry circumcised women [27]. …”

Female genital alteration: a compromise solution

“…The concern regarding amount of tissue being removed is also not unique to FGA, but is similar to male circumcision as well as cosmetic surgeries on adults. Furthermore, the advocacy efforts aimed at completely eliminating FGA have had only limited success; therefore, a new strategy is required that accounts for cultural requirements while safeguarding the health of female children 7. If a girl, by undergoing a small vulvar nick in infancy, forestalls subsequent vulvar infibulation done under dangerous conditions, we would consider this a worthwhile trade-off.…”

“…In a study in Somalia, the country in the world with the highest prevalence of these procedures, 81% of subjects underwent infibulation and only 3% did not have FGA. Eighty-five per cent had an intention to subject their daughters to an extensive FGA procedure, and 90% supported the continuation of the practice 7. There have been some more encouraging studies, however.…”

“…Since progress in reducing FGA procedures has been limited in states where they are endemic and the commitment of people from these cultures to these procedures has led to their persistence in states where they are legally discouraged, alternative approaches should be considered 7. To accommodate cultural beliefs while protecting the physical health of girls, we propose a compromise solution in which liberal states would legally permit de minimis FGA in recognition of its fulfilment of cultural and religious obligations, but would proscribe those forms of FGA that are dangerous or that produce significant sexual or reproductive dysfunction.…”

Female Genital Cutting: Confronting Cultural Challenges and Health Complications Across the Lifespan

“…Prevalence remains high in Somalia, Djibouti and Egypt [77], but change is underway. In Somalia, for example, the adverse consequences of Type III cutting have become more broadly acknowledged; however, some religious leaders defend milder forms of the practice, leading to the erroneous perception that the Sunna form is benign and fulfills religious obligations [37,78]. Prevalence has dropped most dramatically in Burkina Faso, Mauritania and Senegal [7,77].…”