It used to be tradition, but now Somaliland's female genital mutilation ritual is being phased out

When Mumtas Khadar turned nine she couldn't wait for the ritual undertaken by every woman in her village in Somaliland in northeast Africa that she believed would make her more beautiful.

But the traditional practice of female genital mutilation (FGM) left her in agony, bedridden for a week then with painful periods every month and troubles conceiving when she married.

"I was happy as I thought it would be a great dignity for my wedding night," Khadar, now 45, told the Thomson Reuters Foundation in Sanani village on the outskirts of Hargeisa, capital of the self-declared republic of Somaliland.

"It was our culture. Everyone did it. But I'd never do this to my daughters," she said via an interpreter as she sat with other women on the concrete floor of a bare meeting room of the semi-arid village where goats roam the dusty streets.

Khadar, who now has three children, is one of thousands of women being targeted by health workers going village-to-village and even door-to-door in Somaliland which has one of the world's highest rates of FGM, a practice which can kill or maim women.

U.N. agency UNICEF estimates about 98 percent of women aged 15 to 49 have undergone the procedure in the breakaway Islamic state of four million, which has operated independently of Somalia since 1991, but is not globally recognised as a country.

The World Health Organization estimates about 200 million women globally have undergone FGM, which involves the partial or total removal of external genitalia. In Somalia and Somaliland, the vaginal opening is typically sewn almost closed.

Six African countries - Chad, Liberia, Mali, Sierra Leone, Somalia and Sudan - do not criminalise FGM, which world leaders pledged to end under a set of global goals agreed in 2015.

Somaliland last year passed a fatwa, or religious order, to condemn the two most severe forms of FGM, but this left mixed interpretations on lesser forms of FGM and no law has been introduced to punish those responsible.

But Somaliland government spokesman Mukhtar Mohamed Ali said eradicating FGM was a priority and a proposed law - that was amended after opposition from Islamic clerics - is before the president and could be passed by the end of the year.

"We are committed to ending all these practices," he told the Thomson Reuters Foundation in an interview in his office in the government district of Hargeisa, a sprawling dusty city of nearly one million people with few tarmac roads.

"This has been a cultural practice for many years and it is not easy to stop such a tradition ... but there is a lot of respect for the laws in Somaliland."

Grassroots approach

At the Sanani meeting, organised by the Somaliland Family Health Association (SOFHA), all 35 women present had been cut.

Khadan Abdilahi, a manager of a SOFHA clinic who organises awareness sessions in Hargeisa and nearby villages on the harm caused by FGM, said it was a major task to change cultural views and to clarify to women there was no religious basis for this.

Abdilahi, a 32-year-old mother of three, recalled how she was lured onto her grandmother's lap with sweets at the age of five, confused as her screaming sister shouted at her to run.

"I was too young to run away. I did what they wanted," said Abdilahi, whose personal experience drove her to train as a nurse and midwife at Hargeisa's Edna Adan University Hospital.

She said talking to women in villages and medical clinics was starting to have an impact as women for the first time realised many of their health problems were linked to FGM.

This had led to increasing numbers of women opting for less severe types of FGM for their daughters although Abdilahi admitted this was a long way from meeting the U.N. zero goal.

A survey by the Edna Adan Hospital in Hargeisa in 2002 found 98 percent of women with FGM had faced the most severe type, but a second survey in 2013 found this had dropped to 76 percent. The results of a third survey are due out later this year.

"We need to go to every village to explain the complications that arise from FGM. Only then will it stop," Abdilahi said.

"Everyone says this is traditional and you can't stop it and they are still cutting but at least they're now not butchering."

Armed with laminated A5 posters, Abdilahi and other SOFHA and health workers travel the country to explain to women that FGM has no health benefits and can led to painful periods, problems urinating, cysts, infections, and birth complications.

'Not just a woman's affair'

Women at the sessions were encouraged to share their health issues and labour stories, often only then realising that their abdominal pain and increased risk of stillbirth were not normal.

"It was only a few years ago that I realised all the pain I faced and the operations were due to FGM," said Degma Nassan, 60, a mother-of-five from Abdi Idan village on the other side of Hargeisa, dressed in a bright pink Islamic hijab or headscarf.

But other women were harder to sway from the traditional views held by their mothers and grandmothers with some even accusing health workers of being paid - particularly by foreign organisations - to disrupt Somaliland's culture.

"We get mothers who no longer want to cut their girls but the grandmothers insist," said Roda Mohamed Elma, 50, an anti-FGM campaigner on a child protection committee aided by Save the Children at Hargeisa's largest camp for displaced people.

Awo Mohamed, who said she was about 50, said she recently told her son to arrange for his two young daughters to be cut.

"This is from our culture and we don't want to change our culture," she told the Thomson Reuters Foundation in a traditional hut or buul in the remote, pastoral village of Abdigeedi, 160 km (100 miles) northwest of Hargeisa.

"I got this from my mother, my father, my family."

Veteran anti-FGM campaigner Edna Adan Ismail, who was Somaliland's former first lady and the first female foreign minister, was confident views were slowly changing.

Adan, who trained as a nurse and midwife in Britain in the 1950s after she underwent FGM as a young girl, set up the Edna Adan University Hospital in 2002 to take the lead on training women on healthcare and spreading the word, particularly on FGM.

"When I started to talk about FGM in 1976 no country would let me talk about it publicly on their stage," said Adan, who lives in an apartment on the hospital complex.

Adan said at least now the issue was raised on the global stage but it needed to be taken more seriously.

"I want men to join the fight now and it not just be a woman's affair," said Adan, whose business card features a map of Africa with an arrow pointing to Somaliland.

Abdilahi from SOFHA said it was her dream that one day Somaliland would be free from FGM.

"But the only way this will stop is for everyone in our community - women, men, health professionals, village elders, religious leaders - to come together on this," she said.