A Study of Female Genital Mutilation

If you are interested in reading about the issue of Female Genital Mutilation (FGM) from every angle, then you’ll definitely want to look at the Africa Journal of Urology. This entire issue is dedicated to FGM.

“In line with the objectives of the Pan African Urological Surgeons’ Association (PAUSA) to give special concern to health problems in Africa, the editorial board of the African Journal of Urology (AFJU) has decided to publish this special issue on female genital cutting/mutilation (FGM). Addressed to African health care providers, this issue emphasizes the myths behind the continuation of this tradition, types of FGM, their tragic effects on women’s health, and the measures that are being taken to eradicate the practice.

“In this issue, subject experts address a range of FGM-related topics that include epidemiology, public misconceptions, challenges ahead and religious perspectives of FGM of Islam, Christianity, and Judaism. The health implications of FGM, including reproductive issues, psychological repercussions and sexual complications are also addressed, as are the socio-cultural factors contributing to the continuation of this practice and the efforts to oppose it.

“According to the World Health Organization (WHO), about 140 million girls and women worldwide live with the health consequences of FGM, including 101 million living in Africa, mainly in the sub-Saharan areas.”

Female Genital Mutilation Los Angeles

Edna Adan, speaking in Los Angeles, describes Female Genital Mutilation after which the victim is stitched up using thorns.

  1. Female genital cutting/mutilation in Africa deserves special concern: An overview
  2. The Islamic view on female circumcision
  3. The Jewish and Christian view on female genital mutilation
  4. Female genital mutilation: A tragedy for women’s reproductive health
  5. Female genital mutilation: Tradition versus human rights
  6. The continuing challenge of female genital mutilation in Sudan
  7. Psychosocial and sexual aspects of female circumcision
  8. Debunking myths about female circumcision
  9. Medicalization of female genital mutilation/cutting
  10. International efforts on abandoning female genital mutilation
My Work is Not Done – by Wanda Chestnut

My Work is Not Done – by Wanda Chestnut

This article is by Wanda Chestnut, RN, DHSc, an HIV/AIDS Specialist from Glen Dale, Maryland. Even while working full time, and completing her advanced degrees, Wanda managed to participate in three medical missions to Ghana through her church in 2004, 2005 and 2006. In December 2012 she traveled to Hargeisa, Somaliland to volunteer and complete her Doctoral internship at the Edna Adan Maternity Hospital where she will return as a volunteer with Nurses for Edna, through the nonprofit organization, One Nurse At A Time in August.

“My Work is Not Done” – originally published @ The Huffington Post

In December 2012, I had the honor of voluntarily traveling to the Edna Adan University Hospital in Somaliland for two weeks to learn, understand, educate and care for women who had been subjected to Female Genital Mutilation (FGM). Additionally, my desire was to also use my skills as a nurse in any way that I could.

Prior to my trip to Somaliland, and even after my return to the U.S., my colleagues and friends would ask me why I chose to go there. My answer was that while I was doing research about FGM for my doctorate, I came across the hospital’s website. After reading the website in detail, and viewing all of the online video clips about Edna that I could find, I felt the pull at my heart to go there and help. I was so intrigued by Edna, her passion for the people of Somaliland and her desire to eradicate FGM, that I knew I had to meet her.

It took close to six months for us to make contact. After a few exchanges via telephone and by email, she graciously gave me the green light to come. Edna supplied me with the names and contact information of previous volunteers that I could speak with, about their experience and obtain answers to some questions that I had.

Although I had traveled to Africa three times previously, I had never traveled alone. Needless to say, I was a little nervous; however, I was not going to let my nerves stop me. I took the 15-hour flight to Somaliland on an early Sunday morning in December. Edna’s staff met me at the airport.

The ride from the airport to the hospital was a long two and a half-hours, but the scenery was absolutely amazing. The roads were unpaved and there was visual evidence of the war approximately 21 years ago. Despite the rubble remains of what were once homes, and possibly businesses, Nomads and other Somaliland people were seen along the countryside. These people in spite of their living conditions, appeared to be content in their situation.
When we arrived at the hospital, I was greeted by Maah, Edna’s assistant, who was so kind to me and made sure that I had everything I needed for my stay. That evening I met my mentor Dr. Kitto at dinner. She was a very jolly person, and before long, we became inseparable. She was passionate about her work, and turned out to be an awesome mentor who taught me a lot.

While in Somaliland, I had the unique experience of interviewing a local, traditional cutter in order to understand the cultural beliefs and traditions of FGM. I believed that the information from the cutter would be vital in devising my education plan.

A traditional cutter is a woman who performs FGM on girls between the ages of five-thirteen. The cutter confirmed that it is a tradition to “cut,” or surgically close the vaginas of young girls until marriage to prevent them from engaging in sexual intercourse with any other men besides their husbands. Although FGM is banned in Somaliland, the cutter stated that she performs the procedure on 15-20 girls per day. The cutter also reported that she charges $15-$20 per procedure.

When asked if she would ever consider discontinuing the practice of FGM, the cutter responded, “Not unless I am blind or dead.” Having performed the procedure on her own daughters and granddaughters, the cutter affirmed her belief in the continued practice of FGM. She went on to say that, there is no other line of work in her country that would allow her to make the amount of money that she currently makes.

While at the hospital I also assisted in the de-infibulation procedures of several women. De-infibulation is the surgical procedure used to open the “closed” vaginas of women who were subjected to FGM as children. While heart wrenching, I felt that it was important to participate in the procedures to fully understand how to educate the woman of Somaliland.

The women undergoing de-infibulation were terribly frightened as they were being prepped and cut open. Surrounded by a team of competent clinicians who now viewed the procedure as normal and routine, my role was to offer comfort to these women with a friendly touch and smile.

After interviewing the traditional cutter and actually witnessing the de-infibulation procedures, I shifted my focus to educating and raising awareness among both professional and lay providers of the potential physical and emotional repercussions of FGM. I had the opportunity to spend a great deal of time with over 50 Somaliland nursing students.
One Nurse at a Time

In my lectures and discussions, I reviewed how endemic the practices of FGM still are in Somaliland and emphasized the significant, negative reproductive, urological and mental health sequelae of FGM. Students were grateful to learn more about the cultural practice that, although banned, still negatively affect many women and girls.

During my time at the hospital 27 babies born, all with good outcomes. I assisted in the delivery of approximately one third of those births. I also assisted with postpartum assessments, taught mothers how to breast feed their newborn babies, and educated many Somaliland women and men on FGM.

While working on the hospital’s maternity ward, I also shared information with practicing locals physicians and nurses on FGM. In addition, I carefully presented facts about the practice, including the long-term sequelae of the traditions of FGM. Maintaining the delicate balance of respecting cultural traditions and raising awareness about the ill effects of a practice rooted in the history of that culture was instrumental in my success in connecting with the people I encountered.

It was a privilege and an honor to volunteer my knowledge of western nursing practice, and medicine, to educate nurses, health care professionals and patients on the taboo subject of FGM. While valuing the culture and beliefs of the people of Somaliland, I believe that I was still able to make an impact by educating the current and future health care professionals on the effects of FGM.

I cannot thank Edna enough for affording me this opportunity. While my visit to Somaliland is over, my work around FGM is not over. I am committed to educating my colleagues in the U.S., increasing awareness about Somaliland and the wonderful people there, encouraging others to volunteer their time and talents, and providing financial resources to deserving nurses to help them further their education. And, I will be back in Hargeisa in August to volunteer!

Visit Nurses for Edna

International Day of Zero Tolerance to Female Genital Mutilation

Today is International Day of Zero Tolerance to Female Genital Mutilation, which is a condition suffered by approximately 140 million women worldwide.

Edna Adan has always used her hospital and her notoriety to educate the people of Somaliland to reject this practice, which has extraordinarily deep roots in the culture throughout the Horn of Africa.

On this day, Edna has provided the following statement.

As a midwife, I have been delivering babies for 50 years, many of whom were being born to women who had undergone FGM. Witnessing the FGM-associated complications that many were suffering caused me to speak out against it in public in 1976 which at that time shocked my family and my people.

37 years later, and after so many resolutions have been passed to eradicate the practice, we sadly found that 97% of our women still suffered FGM as shown in the survey carried out on 4000 women at the Edna Adan Hospital between 2002 to 2006.

We are still looking for resources to study the prevalence of FGM and hope that the next survey/audit will reveal a reduction of FGM in our women, particularly after all the campaigns that we have held over the years.


For much more detailed information about FGM as practiced in Somaliland see this link:

FGM as practiced in Somaliland

This map indicates the prevalance of Female Genital Mutilation, also known as Female Circumcision, in Africa.
FGM has no place in Islam
FGM Prevalence in Africa

And here is an article by Kate Grant, from our partner organization, The Fistula Foundation, writing about. Fistula and FGM


Edna Adan Ismail: a Somali Inspiration

Edna Adan Ismail: a Somali Inspiration

The following profile was written by Joanne Butcher, BA Politics, University of Sheffield, and published here: Edna Adan Ismail: a Somali Inspiration

Born in Hargeisa in 1937, Edna Adan Ismail is one of Somaliland’s most prominent public figures. From 1954 to 1961, she studied in Britain – the first Somali woman to do so – to become a nurse and midwife. After working as a civil servant, she held the position of Minister for Family Welfare and Social Development and most notably held the title of Somaliland’s Foreign Minister from 2003 until 2006. Throughout the 1980s, she served as advisor to a range of councils at the World Health Organisation before retiring in 1997 when she dedicated her life to her most recent project: the Edna Adan University Hospital.

Alas the gravity and magnitude of Ismail’s career is lost in simply detailing her achievements. It’s important to remember that Edna Adan, as a young girl growing up in Somaliland, was not expected to go to school or acquire any qualifications. “Britain used to select boys from secondary schools to study in England and in 1952 or 53. The very first school for girls was opened in Somaliland and I was a pupil-teacher at the time,” she remembers.

It was a year of waiting before she and another girl were finally sent off to study nursing. “We were the only two [Somali] girls in London at the time. It was very challenging; it was a great opportunity to study something that I certainly felt very passionate about. I loved learning, I loved studying and to be given this opportunity was a great gift, and I loved every minute of it.”

However, on returning to her homeland, she found her dreams of making a Florence Nightingale debut were squashed by the newly independent Somaliland government. “I was the only woman, the only qualified female nurse running all the female section of the hospital,” she explains. “So that was challenging, and of course there were very few doctors and many of the emergencies and the medical care that was needed was beyond the training of a nurse. Very often I just had to substitute for what a doctor would have done, because there would be no doctors. So, very often you just had to do what you had to do.”

It took the government nearly two years to finally concede defeat. “I refused to quit,” she declares. “I just worked for 22 months without a salary. I just stuck to my guns and eventually, they had to give in. I was appointed to the civil service. So, to me, that was a victory because that opened the door to women to be appointed to the senior civil service.”

While working for both the World Health Organisation and the United Nations, Edna Adan had made several attempts to set up a hospital of her own. However, efforts were often thwarted by the political climate. The civil war with Somalia had left Somaliland completely ravaged. Medical professionals had either fled the country during the conflict or been killed by enemy forces. Hospitals had been destroyed in the fighting, leaving the country with one of the highest maternal and infancy mortality rates in the world. “I just recycled my whole life,” she explains. “I just turned everything I could dispose of into cold cash and started to build a hospital.”

Edna Adan’s credentials as a nurse, a midwife and a health advisor, made her one of the most qualified people to set up a medical centre. But, according to Ismail herself, it was the memories of her father that truly stirred her to establish the Edna Adan University Hospital.

“My father was someone who was known as the father of healthcare in Somaliland,” she recalls. “As a teenager I would be home for the holidays, from school in Djibouti, and I would be hanging around the hospital, giving him a hand. And I would often hear him complaining about a piece of equipment, and I just made a kind of mental, subconscious promise that one day I would build the kind of hospital my father would have liked to work in.”

The Edna Adan University Hospital started life as a maternity hospital. After four years building on what used to be a garbage dump, the hospital was opened in 2002. For over a decade, the hospital has taken in literally thousands of patients and, to this day, continues to expand. Despite her position as both the founder and director of this monumental institution, Ismail remains humble about her contribution. “I’m doing less and less legwork,” she notes.

But Ismail is kept busy by the cascade of political issues that still flood the hospital. Gender politics still lie at the heart of what she does in Somaliland. The hospital, along with educating women to become nurses and midwifes, is using its influence to try and stop female genital mutilation – a tradition still practised in parts of Somaliland. “The more we do, the more we see that more needs to be done,” she admits. “What we’ve done now is a drop in the ocean.”

However it’s not just within the walls of the hospital that women are treated unequally. Ismail remains as passionate about gender equality as she was as a little girl. It’s important to note that when she was young, only boys were educated in Somaliland. “At that time, education was considered undesirable for a girl,” she explains. “Friends and relatives would come and say ‘God has given you one daughter and you are teaching her to read and write? What good will come of it? She will disgrace you!’ I grew up with that and I was always trying to prove to them that education was good.”

When she sat in Cabinet in the new millennia, she was the only female minister around the table. Even now there are only two women elected to Parliament and just one female in the Senate. “This is what I’ve had to fight all my life and we continue to fight because it needs to be fought. Somebody’s got to speak for these voiceless women. Somebody’s got to stand their grounds. If I had that opportunity to do that then I must do it. It’s a responsibility that I must accept.”

There’s no doubt that progress has been made. Once upon a time women were not even allowed to drive cars, and Ismail agrees that the changes that have occurred have made her optimistic about the future for women in Somaliland. “I would like the change to be bigger and I would like more women to keep that pressure going,” she says. “The world needs both men and women. Because it’s not a question of men or women, it’s a question of both men and women doing a job together to make the world a better place for humankind. That’s all.”

Throughout her life, education has been at the core of everything she’s accomplished. Her thirst for learning has fuelled her career and now she intends to impart her wisdom onto others in hopes that they will continue her mission. “My real gift that I wish to leave for my people is the gift of knowledge; for them to love knowledge – to encourage them to seek more knowledge.”

As always Ismail practices what she preaches and has dedicated her later life to encouraging young women to join the profession. She notes that it is still hard to persuade Somali families to let their daughters study but over time Ismail has persuaded masses of girls to take the opportunity to become a nurse or midwife. “These are exciting years,” she exclaims. “I am proud that the first lady of Somaliland today was one of those young students, young women who we talked into taking up nursing in those days.

There’s still a mountain ahead for Edna Adan Ismail, but she’s still enthused by the belief that people need change and its these young women who are able to deliver it them. “I want to be a role model, to show them that anyone can do it and so can you,” she explains.

Her love for what she does and her ability to convey such a wealth of knowledge onto others is what has made Edna Adan such an influential and compelling teacher. “I feel blessed at 74 that I can still do that. An old woman following her lifelong passion. And loving every minute of it.”

The preceding profile was written by Joanne Butcher, BA Politics, University of Sheffield.

Ask Edna

Ask Edna

United States Senator Kirsten Gillibrand (NY) has published to her web site, Off The Sidelines, a page of Questions and Answers, questions from her Book Club members addressed to Edna Adan.

The goal of Sen. Gillibrand’s group is to make more women aware of the need to be involved in the decisions that affect their lives every day and to let women know that their voice matters, to give them the resources to start to get more involved and tell the inspiring stories of women who already are. She says, “I’m so proud that today, for International Women’s Day, Edna Adan has agreed to answer some of our book club members’ questions, which we’ve posted at Off The Sidelines here.”

Edna discusses how she decided, at the age of 11 or 12, to study nursing and how she broke a taboo by speaking out against Female Genital Mutilation. Describing what has contributed to making her successful in her endeavors, Edna cites her “rebellious character and the courage to speak out against what I find to be unjust.”

She also discusses in some considerable detail what the hospital is looking for in the way of Volunteers and the process that leads to their being accepted.

Thankfully, we do not have in Somaliland all of the atrocities mentioned in “Half The Sky” but whatever atrocities exist in a community should be stamped out. The one that exists and persists in my community is female genital mutilation or female circumcision. I rebelled against it first because it has affected me personally, and secondly because I am a midwife and in my profession, I see on a daily basis how women’s bodies are damaged by this practice. I guess I just reached a point in my life when I couldn’t take it anymore and I just kind of exploded. I have been fighting against the practice ever since. [more]

Off the Sidelines

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