Abstract
Background:
Skin bleaching is the cosmetic use of hazardous substances or skin lightening agents to change one’s natural skin pigment. Skin bleaching products contain substances such as corticosteroids, hydroquinone, mercury salts, and other compounds that decrease the melanin.
Objective:
To assess the prevalence of skin bleaching and identify the motivating factors among female university students in Mogadishu, Somalia.
Design and methods:
This cross-sectional study included 317 female university students in Mogadishu, Somalia, from February to July 2024. Structured questionnaires were used for data collection. Data analysis was performed using IBM SPSS Statistics version 27.0, reporting categorical variables as frequencies and percentages; significance was determined at p < 0.05 for both crude odds ratios in univariate analyses and adjusted odds ratios (AORs) in multivariate analyses.
Results:
Almost 77.3% of participants showed awareness of skin bleaching, with main information sources mentioned as media (39.7%) and friends (34.1%). Two-thirds (63.4%) reported experiencing skin conditions like acne (27.1%). Univariate and multiple logistic regression analyses were conducted. From the results, only female students with a monthly income between USD 50 and 100 were 1.21 (AOR = 1.21, 95% confidence interval: 1.102–1.6341) more likely to bleach their skin compared to those with an income less than USD 50.
Conclusions:
The study reveals a high prevalence of skin bleaching practices among female university students despite widespread awareness. Media and peer influence play a major role, and many participants reported adverse skin effects. Monthly income emerged as the key factor associated with skin bleaching, underscoring the need for targeted public health education and interventions.
Introduction
Skin bleaching is the cosmetic use of hazardous substances (e.g. mercurials) or abuse of skin lightening agents (e.g. topical corticosteroids) to modify one’s natural skin pigment. 1 Skin bleaching products contain substances such as corticosteroids, hydroquinone, mercury salts, and other compounds that decrease melanin so that a lighter skin colour can be achieved. 2 Different communities interpret beauty standards in diverse ways. 3 A common distinction is made between outward physical appearance and inner qualities such as character or personality. 4 These perceptions are often shaped by cultural and social influences, which vary depending on where an individual lives, and they tend to reflect both external looks and internal traits. 5 Earlier qualitative interviews with women in India, Egypt, and Ghana examined how cultural traditions and historical factors have contributed to the perception of light skin as an ideal of beauty. 6
Bleaching has become a widespread practice worldwide despite potential adverse effects and negative consequences. 7 Even though skin bleaching is practiced by both men and women, women are more prone to perform the practice than men.8,9 In a recent meta-analysis, the lifetime prevalence of using skin bleaching products is 27.7% worldwide, with the African region reporting a prevalence of 27.1%. 10 Meanwhile, numerous other findings have shown varying degrees of skin bleaching practices, with prevalence rates reported at 38.9% in Saudi Arabia, 30% in China, 20% in Taiwan, 18% in Japan, and 8% in Korea.11–13 However, in Africa, usage of skin bleaching cosmetics was drastically high, with a prevalence of 27.1%. 10 Also, other studies reported a rate of 52% and 67% in Dakar and Senegal, respectively, followed by 58.9% in Togo and 25% in Bamako, Mali. 13 Furthermore, a study conducted in Lagos, Nigeria, reported a higher estimate of 77% of women using skin bleaching goods.14–17
Recent studies have highlighted various motivating factors of skin bleaching practices. Even though the factors vary depending on the context and locality, the desire to enhance attractiveness, confidence, self-esteem, and spouse’s appreciation are common motivating factors.1,18 Study conducted in Tanzania revealed that women are motivated to attract male partners, impress peers, remove skin imperfections, achieve smoother skin, reverse damage from previous bleaching, and attain a lighter skin. 19
Nevertheless, long-term skin bleaching with toxic chemicals has been linked to negative consequences such as local dyschromia as well as systemic complications, including diabetes and hypertension.17,20,21 In addition, chronic use can lead to skin thinning and atrophy, which may cause complications such as keloidal scarring, payroll dermatitis, contact allergic, irritant dermatitis, acneiform eruptions, striae, hypertrichosis, telangiectasias, as well as fungal and bacterial infections. 22 A study among female students in northeastern Nigeria revealed a high usage of toxic chemical agents to bleach their skin despite being aware of the associated risks. 23 The practice of skin bleaching was also more commonly reported among young, unmarried, and educated women. 24
A previous study conducted in Borama, Somalia, found that one in four (25.6%) of female health science students had used skin bleaching products in the past, and as high as one in two (52.2%) were still using them at the time of the study. 10
In Somalia, lighter skin is often culturally associated with beauty, higher social standing, and privilege, leading to widespread use of skin-lightening products. 25 Additionally, these products are frequently used without guidance from healthcare professionals. Over the past 15 years, Mogadishu has experienced a marked growth in cosmetic shops and beauty salons, contributing to the widespread use of skin-lightening products. 25 Despite the widespread use of skin-bleaching products, little is known about their prevalence and the factors motivating their use among female university students in Mogadishu, Somalia. This study aimed to assess the prevalence of skin-bleaching practices and explore the motivating factors behind their use in this population.
Materials and methods
Study location
This cross-sectional study included female participants from various universities in Mogadishu. Mogadishu, Somalia’s capital and most populous city, is home to approximately 2 million residents. 26 Mogadishu also offers a range of higher education opportunities, with several institutions providing diverse programmes to support academic growth and research. The city’s commitment to excellent education is evident in the continuous development and expansion of academic institutions, striving to make it a leading hub for learning and research in the country.
Study design
A cross-sectional descriptive study was conducted among undergraduate female university students in Mogadishu, Somalia, from February to July 2024.
Study population
The study population consisted of female undergraduate students enrolled in selected public and private universities during the study period.
Inclusion criteria
Female undergraduate students enrolled in the selected universities during the study period and those who provided informed consent. Only female university students aged 18 years and above were eligible for participation. No participants younger than 18 years were included in this study. Exclusion criteria
Female students who had already graduated were in the foundation/year zero programme, and those who submitted incomplete questionnaires.
Sampling technique
A multistage simple random sampling technique was employed. In the first stage, public and private universities were randomly selected from all accredited universities in Mogadishu. Those universities host a large number of female students in Mogadishu. Eligible universities were those offering active undergraduate programmes with enrolled female students. In the second stage, lists of registered female students were obtained from each selected university, and participants were proportionally selected using simple random sampling based on student registration numbers. The universities included in the study were Jazeera University, Plasma University, Banadir University, and Somali National University.
Sample size determination
The sample size was calculated using the single population proportion formula, assuming a prevalence of skin-bleaching practices of 24.5%, based on a previous study, 20 with a 95% confidence level and a 5% margin of error. After adding a 15% allowance for non-response, the final required sample size was 327. However, a total of 317 participants agreed to participate in this study.
Data collection procedure
Data were collected using a pre-tested, structured, self-administered questionnaire developed specifically for this study based on a review of relevant literature and previously published studies on skin bleaching practices.20,27 The questionnaire consisted exclusively of closed-ended items and was administered to selected female undergraduate students in Mogadishu between February and July 2024. Prior to data collection, participants were approached, the purpose of the study was explained, and written informed consent was obtained. The questionnaire was pre-tested among a small group of female university students to assess clarity, relevance, and comprehensibility, and minor wording adjustments were made accordingly before the main survey. The instrument was divided into four main sections. Section A collected socio-demographic information, including age, marital status, self-reported skin colour, semester of study, area of residence, study programme, and average monthly income. Section B assessed awareness and knowledge of skin bleaching, including prior awareness, sources of information, perceived purpose of skin bleaching, knowledge of ingredients, perceived health risks, and awareness of safety requirements for cosmetic use. Section C measured the prevalence and patterns of skin bleaching practice, including lifetime use of skin bleaching products (the dependent variable), types and brands of products used, product preference, frequency of use, reasons for use, occurrence and type of skin problems experienced, monthly expenditure on products, preferred body parts for application, and sources of product purchase. Skin bleaching practice was operationally defined as self-reported lifetime use of any skin bleaching product and was measured using a single binary (yes/no) question. Section D assessed motivating factors for skin bleaching practice by asking respondents to identify their primary motivation from predefined categorical options, such as social pressure and personal preference for lighter skin. The questionnaire was pre-tested among 10% of the total sample size (n = 33) to assess clarity, consistency, and feasibility prior to the main data collection. Completed questionnaires were checked for completeness on site prior to data entry and subsequent analysis.
Statistical analysis
Data analysis was performed using Statistical Package for Social Sciences, version 27. Categorical variables were presented as numbers and percentages. Univariate and multivariate analyses were conducted to identify predictors of skin bleaching practices. The final analysis employed the 95% confidence limit, with a two-tailed test requiring a p-value of <0.05 to be considered significant.
Ethical consideration
Ethical clearance was obtained from the Research Ethics Committee of the Jamhuria University of Science and Technology (JUREC0092/FMHS00307/052024). Written informed consent was obtained from the participants before they answered the questionnaire.
Results
Socio-demographic characteristics
Table 1 shows the socio-demographic characteristics of 317 female students from Mogadishu, Somalia, who participated in the study. More than half of them (54.3%) were aged ⩽20 years, and the majority of them were single (93.7%). In terms of skin colour, about half (53.9%) reported themselves as fair-skinned. About 40.7% of the participants were in semesters five and six of their studies, and two-thirds (67.5%) were enrolled in health-related programmes. Most of them resided in Mogadishu (95.6%). Above half of them (57.1%) reported an income of equal to or less than 50 USD per month.
Socio-demographic characteristics of study participants (N = 317).
Awareness of skin bleaching
Table 2 presents the awareness level among participants about skin bleaching. The findings revealed that a significant proportion of participants (77.3%) were aware of skin bleaching, with their primary sources of information being media (39.7%) and friends (34.1%). The participants also reported varying perceptions of skin bleaching, with the majority associating it with changing human colour (38.1%) and using chemicals on the skin (26.8%). Besides, two-thirds of participants (63.1%) knew about the ingredients used in skin bleaching, while most of them identified several recognized dangers, including skin cancer (51.7%) and multi-coloured skin (18.6%).
Awareness and knowledge of skin bleaching among study participants (N = 317).
Prevalence and use of skin bleaching products
Figure 1 illustrates the prevalence of skin bleaching practice. From the study, 46.7% of participants reported having used skin bleaching products before. The most commonly used products were Derma Glow (13.9%), Dernmo Light Cream (7.3%), and Pretty White (6.0%). Interestingly, 49.2% of participants denied using any skin bleaching products before. As for the reasons for using these products, about half (52.4%) mentioned the reason as enhancing beauty and ensuring healthy skin, while 8.5% desired to boost self-esteem. Additionally, 63.4% of participants reported experiencing skin problems, with acne being the most common issue (27.1%). In terms of frequency, about one-third (35.6%) used skin bleaching products daily, and 12.9% used them twice daily. Regarding expenditure on skin bleaching products, 17.4% of them spent USD 40 or more per month. Almost two-thirds of them (63.7%) intended to perform skin bleaching on their faces. Most of them (64.7%) purchased the skin bleaching products from cosmetic shops (Table 3).
Prevalence of skin bleaching practice among female university students in Mogadishu, Somalia.
Prevalence of the usage of skin bleaching products.
Motivation factors
Figure 2 indicates that a high percentage of participants (33.1%) reported social pressure as the main reason for using skin bleaching products. Additionally, a significant proportion, 30.9%, mentioned personal preferences for whiter skin as their motivation. Notably, social pressure emerged as the predominant factor, slightly surpassing personal preference in reported motivation.
Motivating factors for skin bleaching practice among female university students in Mogadishu, Somalia.
Association between socio-demographic characteristics and skin bleaching practice
Table 4 presents the association between socio-demographic factors and skin bleaching practices. Among the factors examined, only income demonstrated a significant difference (χ2 = 8.653, p = 0.013) between individuals who reported using skin bleaching products and those who did not. All the other socio-demographic factors did not show any significant differences in relation to skin bleaching practices among the study participants.
Association between socio-demographic characteristics and skin bleaching (N = 317).
and bold values in Table 4 indicate variables that were statistically significant at p < 0.05.
Predictors of skin bleaching among study respondents
Univariate and multiple logistic regression analyses were conducted. From the results, only female students with income between USD 50 and 100 were 1.21 (adjusted odds ratio = 1.21, 95% confidence interval: 1.102–1.6341) more likely to bleach their skin compared to those with income less than USD 50 (Table 5).
Predictors of skin bleaching practice.
COR: crude odds ratio; AOR: adjusted odds ratio; CI: confidence interval.
p < 0.05.
Discussion
This study aimed to assess the prevalence of skin bleaching practices and their motivating factors among female university students in Mogadishu, Somalia. Skin lightening is a growing global public health concern, especially in developing countries where weak regulatory frameworks and aggressive marketing fuel its use, particularly in Mogadishu, Somalia, where awareness of the hazards of skin lightening products remains critically low among users. 25 The current study reported that the prevalence of skin bleaching practice among the study participants was 46.7%. The finding is slightly lower than a previous study conducted among female health science students at the Amoud University in Borama, Somalia (52.2%). 10 The discrepancy may be explained by stability, and the ease of obtaining skin-lightening products, including their availability in local markets and affordability, can differ between Mogadishu and Borama.
Income emerged as the only socio-demographic factor significantly associated with skin bleaching practices. Female students with a monthly income between USD 50 and 100 were more likely to engage in skin bleaching compared to those earning less than USD 50. This finding aligns with evidence from Mumbai, India, where income level influenced access to and use of cosmetic products. 28 Our study found no significant association between skin bleaching practices and marital status, skin colour, or area of residence in this study. This suggests that skin bleaching behaviour in this study population may be driven more by individual and socio-economic factors than by demographic characteristics. These results contradicted previous studies in which darker-skinned individuals, married women, and those living in urban areas were more likely to perform skin bleaching.18,29 One of the possible explanations could be that a significant portion of the Somali population has fair skin. Nevertheless, the study highlighted that a significant portion of study participants (77.3%) were aware of and engaged in skin bleaching practices, with media and friends being the primary sources of information. This high level of awareness is similar to findings in other African countries, such as Nigeria and Ghana. 21
More than one-third of our results mentioned that skin bleaching is a method of changing skin colour. These findings are consistent with other studies conducted in Nigeria and Ghana.14,18 Furthermore, about half of them recognized that skin bleaching practice can potentially cause skin cancer. Similar findings have been found in other regions in sub-Saharan African countries, in which the participants also acknowledged that skin bleaching products containing mercury and hydroquinone can increase the risk of skin cancer. 21 Additionally, 63.1% of participants were aware of the ingredients used in skin bleaching. These findings align with a study in Jordan, in which the participants could identify the active ingredients used in skin bleaching products. 30
Notably, the participants of this study expressed a preference for local brands of skin bleaching products, as compared to other countries such as Kenya and Tanzania, with a preference toward international brands. 16 Local products might be more favoured in Somalia due to their affordability and availability. Nevertheless, these local products may lack regulatory oversight, hence creating concerns about safety and quality. In terms of the frequency of usage, 35.6% of the participants reported using skin bleaching products daily, due to their strong desire for rapid and continuous skin bleaching. A similar high frequency of usage was also observed in studies conducted in Southeast Asia and the Caribbean due to societal pressure to maintain lighter skin colour.14,31
Unfortunately, such excessive use of skin bleaching products can pose serious health hazards. About two-thirds of the study participants reported skin problems following the use of skin-bleaching products, including acne and skin irritation. Similarly, a study in India and Jamaica has also reported acne as a common problem among the users of skin bleaching products, likely attributed to the occlusive and comedogenic features of some bleaching creams.31,32 More than half of the participants applied skin bleaching creams on their faces, similar to a study among female medical undergraduates in Nigeria in which 60.0% of the participants used skin bleaching products on their faces. 2
Lastly, the highest motivating factor for the use of skin bleaching products was societal pressure. This finding aligns with a prior study in Tanzania in which interviewees described experiencing social pressure to be light-skinned. 33 Some of them also mentioned personal preference as their motivation, similar to the reasons quoted in another study, whereby the use of skin bleaching products was seen as a lifestyle and personal choice. 9
Conclusion
In line with the study objective of assessing the prevalence and motivating factors of skin bleaching among female university students in Mogadishu, this study found that nearly half of the participants (46.7%) reported having ever practiced skin bleaching, indicating that the practice is common within this population. Although awareness of the potential harmful effects and ingredients of skin bleaching products was relatively high, social pressure, peer influence, and media exposure emerged as prominent motivating factors. Higher income was the only factor significantly associated with skin bleaching practice, suggesting a possible role of purchasing power and access to cosmetic products, without implying causality, given the cross-sectional design of the study. The frequent use of largely unregulated, locally available products—particularly on facial skin—was commonly reported and was associated with self-reported adverse skin conditions. These findings highlight the need for targeted, non-causal public health responses, including university-based awareness and behaviour-change programmes, strengthened regulation and monitoring of imported and locally sold cosmetic products, and coordinated public health messaging to address social norms surrounding skin colour and beauty in Somalia.
Strengths and limitations of this study
This is one of the first studies to investigate the prevalence and motivating factors of skin bleaching practices among female university students in Somalia, addressing a significant public health concern in a low-resource setting.
The study used a structured questionnaire with face-to-face interviews, which helped ensure clarity of responses and reduced the risk of misinterpretation.
The use of both univariate and multivariate logistic regression provided a robust analysis of associated factors.
The cross-sectional design limits the ability to establish causality between associated factors and skin bleaching practices.
Significance for public health
Unregulated use of these agents poses serious health risks ranging from cutaneous complications (acne, dermatitis, ochronosis) to systemic effects (endocrine disruption, nephrotoxicity, mercury poisoning). High prevalence among young women can perpetuate long-term morbidity and exacerbate health-related issues. Understanding drivers of skin bleaching is essential to inform targeted interventions, strengthen regulatory oversight, and protect vulnerable populations from product-related harms.
Supplemental Material
sj-docx-1-smo-10.1177_20503121261426851 – Supplemental material for Prevalence and motivation factors of bleaching practices among female university students in Mogadishu, Somalia
Supplemental material, sj-docx-1-smo-10.1177_20503121261426851 for Prevalence and motivation factors of bleaching practices among female university students in Mogadishu, Somalia by Nur Rashid Ahmed, Ahmed Mohamed Dirie, Shafie Abdirahman Dirie, Sayidahmed Abdirahim Sayid, Iqro Mohamed Isse, Zahra Abdi Dahir, Deqo Ali Yacqub, Maido Farhan Ali and Kassim Abdi Jimale in SAGE Open Medicine
Footnotes
Acknowledgements
The authors would like to thank the Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, the Faculty of Health Science, Salaam University, the Jamhuriya Research Center, and the Research and Development Office at Salaam University for their invaluable support and collaboration throughout the course of this study. We also extend our sincere gratitude to the participants and data collectors whose contributions were essential to the success of this research.
Ethical considerations
Ethical approval was obtained from the Research Ethics Committee of Jamhuriya University of Science and Technology.
Consent to participate
All participants signed an informed consent form before study participation. They were given assurance about the data confidentiality and its exclusive use for this research study.
Author contributions
Nur Rashid Ahmed contributed to the conception and design of the study and drafting of the manuscript. Ahmed Mohamed Dirie contributed to the conception, design of the study, data analysis, and drafting of the manuscript. Shafie Abdirahman Dirie contributed to the conception and design of the study, data analysis, and drafting of the manuscript. Sayidahmed Abdirahim Sayid contributed to data collection, data analysis, and drafting of the manuscript. Iqro Mohamed Isse contributed to the data collection, data analysis, and drafting of the manuscript. Zahra Abdi Dahir contributed to the conception and design of the study, data collection, and data analysis. Deqo Ali Yacqub contributed to the conception and design of the study and drafting of the manuscript. Maido Farhan Ali contributed to data analysis and drafting of the manuscript. Kassim Abdi Jimale contributed to the conception and design of the study and drafting of the manuscript.
All authors critically revised the manuscript, approved the final version for publication, and agreed to be accountable for all aspects of the work.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data availability statement
Data are available upon reasonable request from the corresponding author.*
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References
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