The context
Somaliland is an autonomous, self-governing region of northern Somalia. Prevalence levels of FGM/C remain persistently high across Somalia, including Somaliland, despite efforts to reduce them by the governments, international and national NGOs, and CSOs. The Somali Health and Demographic Survey 2020 (SHDS 2020) reports that 99 per cent of women in Somalia, including Somaliland, are estimated to have undergone FGM/C, with 64 per cent having undergone infibulation, the pharaonic cut (WHO Type 3), often resulting in short- and long-term health complications. There is recent evidence of changes in the types of FGM/C being practised in Somaliland, with a movement away from the pharaonic cut to less severe forms of cutting, including pricking or snipping of the clitoris (WHO Types 4 or 1), referred to locally as the sunnah/sunnah 2 (Ismail et al. 2022; Johansson et al. 2021; Newell-Jones 2016, 2017; Powell and Yussuf 2018; SHDS 2020).
Governments and international NGOs have tended to adopt a zero-tolerance stance on FGM/C, calling for the immediate elimination of all forms of female genital cutting. An anti-FGM/C policy was signed in Somaliland in September 2024, based on zero tolerance. This is a step towards FGM/C becoming illegal; however, many obstacles remain. The definition of what constitutes FGM/C in Somaliland is contested, with many defining it as only the pharaonic cut. Zero tolerance towards FGM/C is often seen as externally driven and counter-productive.
Many approaches have been used in Somaliland to end FGM/C, including: educating people about the potential health risks; providing alternative incomes for cutters; girl empowerment initiatives; school clubs; engaging community and religious leaders in dialogue; anti-medicalisation campaigns; engaging youth, especially via social media; community forums; and the engagement of men and boys. The choice is considerable, yet evidence of the effectiveness of these approaches, either individually or combined, in the Somaliland context, is limited.
SOFHA, a member association of the International Planned Parenthood Federation (IPPF), is a CSO established by Edna Adan, founder of the Edna Adan University Hospital, Hargeisa. Initially its remit was to establish a network of evidence-based community-based maternal health centres. With virtually all women and girls in Somaliland being cut, responding to FGM/C is a key aspect of maternal health.