Assessing the Sexual and Reproductive Health Needs of Female Genital Mutilation/Cutting Survivors Accessing Care in Somalia: A Cross-Sectional Survey

**Revised Abstract** This cross-sectional study investigated the sexual and reproductive health (SRH) burden and care needs among female genital mutilation/cutting (FGM/C) survivors in Somalia. It responds to a critical evidence gap concerning the specific health sequelae and service requirements for this population within low-resource settings. A structured questionnaire was administered between March and August 2024 to 418 women (aged 18–45) with FGM/C attending maternal health clinics in Mogadishu and Hargeisa. The sampling strategy, a non-probability convenience sample, is acknowledged to limit generalisability, potentially overestimating morbidity prevalence among survivors actively seeking care. The questionnaire incorporated standardised instruments, including the Female Sexual Function Index (FSFI) and a validated Somali adaptation of the PHQ-9 and GAD-7 for psychological distress, to assess gynaecological, obstetric, sexual, and mental health outcomes. Ethical approval was granted by the Somali Institute of Health Research, with informed consent and safeguarding protocols ensuring participant confidentiality and support. High morbidity was reported: 78% experienced chronic pelvic pain, 82% dyspareunia, and 67% clinically significant anxiety or depression symptomatology. Furthermore, 61% reported major perineal trauma during their last delivery. A salient finding was that 89% identified an unmet need for integrated, specialised counselling. These results demonstrate a substantial unaddressed health burden linked to FGM/C within this clinical sample. The study concludes that strengthening national SRH programmes requires integrating trauma-informed, multidisciplinary care for FGM/C-related complications to improve health outcomes and equity.