Call to action! Let’s all help to break the FGM cycle!

Edna, in Edna Adan Hospital University library
Edna, in Edna Adan Hospital University library

There are increasing calls for zero tolerance on Female Genital Mutilation. One of Africa’s leading voices on the issue is none other than that of the relentless campaigner and humanitarian, Somaliland’s Edna Adan Ismail, who leaves no stone unturned as she exclusively speaks on a practice many believe is well past its sell-by-date.


First of all, tell us more about the Edna Adan Foundation Hospital in your birthplace, Hargeisa, which you built from scratch using your own money, including your pension.
Any woman who has a health problem walks into my hospital. That is whom I built it for. They come for different reasons, from a cough to a heart problem. Making money from the hospital was never my intention. The hospital’s running costs in a year are far more than what it cost to build. Having said that, we also have private rooms for women who can afford to pay something. The US$25 fee is the most expensive rate we charge per day, meals included. Women who don’t have the $25 fee get treated for free. The balance between paid and unpaid patients allows us to survive financially. Everything I earn goes back into the hospital.

I also fundraise and I go wherever anybody will listen. I raise the funds for expertise. I get doctors who come to help and professors who come to teach in our training programmes for nurses, midwives, public health, pharmacists, and now medicine. To me, that is far more valuable than money.

Did your career path in health purposely influence you in the fight against FGM?
After qualifying as a nurse specialising in midwifery in London, I spent some time there helping European women, who had not experienced FGM, deliver their babies. But it was when I came home in 1961 – as the first and only qualified nurse-midwife – that I found myself on the other end, so to speak. I had to help women who had been subjected to FGM deliver, and I had not been trained to deal with that. I had not been trained to help women whose birth passage had been so destroyed. But here I was, I had to do it – cut it [through the sutured passage] to get the baby out as safely as possible for both the mother and the baby.

It makes you feel very angry! Then you remember your own pain. But then again, you recall, you are the well brought-up girl and so you do not speak about it.

FGM is against the teachings of Islam. Sometimes people try to attribute FGM to religious obligations

What would you say was the biggest motivation that pushed you to fight a tradition that is so ingrained in your culture?
It was a long struggle, which went on for many years. I went through FGM myself at the age of seven. But I knew soon enough that what had happened to me was wrong, because my father, who was away when it happened, was very angry to learn on his return, that I had been cut. I have been living with it for 70 years now, but I knew from my father’s angry reaction back then, that it was wrong, it should not have been done to me.

But we are brought up in a culture and tradition where everybody has gone through FGM and, as that well brought up girl, you do not be speaking about it. You cannot bring shame upon your family. So you keep it bottled up inside you.


But you knew you had to do something about it. How hard was that decision?
It was in 1976 when I felt that I had to break the silence and first spoke about the problem in public, much to the chagrin and shame of many. I would be told: “Edna, how can you do this? Are you forgetting who you are? Come on, your husband was the first president of Somaliland, he was the prime minister of Somalia, you are the daughter of Doctor Adan-Ismail. How can you say these things? So much has been spent on your education and these are the things you choose to speak about?”

That was the attitude. But I felt and still feel very strongly against FGM. Female circumcision is wrong, it is against Islam, it is violence against women and girls, it is a human rights violation and I will never stop speaking against it.

Prophet Muhammad had daughters, and they were not circumcised

How hard has it been to have the message against FGM put across and how is it received?
I remember attending a conference in Copenhagen back in 1979, where I noted that the topic of FGM was being pushed aside. And it was only when I insisted that I speak about it, that I got allocated a slot as speaker. In New York we used to lobby at the United Nations. At the African Union (Organisation of African Unity at the time) we used to demonstrate and representatives of the OAU would send out some of their agents to come speak to us or silence us sometimes, even saying we were giving Africa a bad image. In 1983 there was a WHO-sponsored conference in Senegal where we spoke about “harmful traditional practices affecting the health of women and children” – if we had gone there and said we were going to speak about female circumcision, nobody would have attended. Shortly after, we formed the Inter-African Committee (IAC), which spoke about all harmful traditional practices: child marriage, violence against women, health, poverty, diet, obesity, starvation, taboos, divorce, inheritance and FGM. That’s how we squeezed it in, to attract interest.

In other words you have had to sandwich FGM between other issues that appear more appropriate for discussion. But how have you ensured your message engages and registers to create an external conversation?
I focus on the health aspect of the Female Genital Mutilation issue. Every woman who has experienced FGM knows the pain they have gone through: what happens when they get married and they have to be opened up; when they are menstruating; and when they are giving birth.

They already know. I do not have to explain that. I therefore speak on how to prevent what happened to them from happening to other girls and women. It is in the same way that I speak about immunisation to prevent children from getting measles or polio. It is the same with FGM. We can prevent causing injury, pain, haemorrhage, infection and death of the child or mother or both, caused by female FGM.

Another solid argument is of course that FGM is against the teachings of Islam. Sometimes people try to attribute FGM to religious obligations. Our prophet (peace be upon him) had daughters, and they were not circumcised. That is proof that it is not a religious requirement.


When did you feel the effects of your work and when do you think the world validated the issue of FGM?
Between 1986 and 1997, while working for WHO as regional adviser for all things concerning gender and harmful practices, we coined the description Female Genital Mutilation, because Female Genital Cutting, that people tend to use, is not correct. Cutting is just something that you cut and throw away. But FGM is a mutilation; you change the aspect of something. You cut it, then you suture it together, and that changes the shape, diameter and proportions. Therefore, it’s not cutting. Cutting is already bad within itself, but mutilation is even worse. Some women are cut, but the majority of them are cut and sutured together, in another word; infibulated. Infibulation is a mutilation!

Where does the FGM eradication battle stand now? Have things developed in ways you would have imagined 20 years ago?
Where are we now? Well, young girls are still being cut. While we appreciate that for the first time some resources are actually being allocated to fighting FGM, some people are also profiting financially from the misery of little girls facing FGM and also, sadly also, FGM is not being fought in Africa, but mainly in the Western world forums.

For instance, I cannot go and campaign in another country where I do not speak the language and do not have access to its women. But I can speak to Somali women. I have access to villages, I speak their language. You also have to speak in a way that the audience you are speaking to understands. You have to speak to them with humbleness and approach them with respect and sensitively. You cannot say to them they are criminals, or that they are guilty of human rights abuses. With such an approach, no message will be heard.

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What do you think is lacking in FGM eradication campaigns? What are the activists and FGM fighters overlooking? Are there specific factors that may need closer consideration?
We have been having this conversation at conferences for 40 years. People need to go to the affected countries, sit on the ground, sit on the stone, sit on the mats in the little huts, and speak the language, which these grandmothers and mothers speak. Speak to them in a way that they will understand.

We also need to understand that the decision to cut a child is taken by the parents. Legislation is good, but it doesn’t have an effect on what happens in the homes where these girls live. In Somaliland we have a population of four million, 50% are female. Basically, two million women, whether there is legislation or not, could allow their daughters to be cut. Will we put two million women in prison? No, because it’s not a realistic option. The only way legislation can be effectively reinforced is by taking action against those who do the actual cutting. These cutters are the ones that need to be educated about their actions and have the law thoroughly explained to them and the consequences of their actions within the law.

Cutting is already bad within itself, but mutilation is even worse

Big posters are not going to reach the grandmothers in the villages. There is no point. How many resolutions have been passed, and how many laws propagated? We used to fight to have legislation, which is good because they get governments committed. But they still do not stop grandmothers from doing the cutting. The solution lies with the grassroots people in affected countries. They are the ones who should be speaking about FGM. It is not the glitz and glamour that is going to bring change.

Are you saying it is all about who the campaigners are?
It should be campaigners within the 18 African countries have officially banned FGM; this shows inclination to rid the practice. Which other ways can they prove commitment? Sudan banned FGM in 1947, it was the first country to do so. And what effect has it had? None! In 1995, Djibouti passed legislation No. 555 but that didn’t stop the young girls from being cut. I still get young girls brought to my hospital bleeding to near death at 10 o’clock in the night as last resort, after they have been bleeding all day. Before bringing them to me, or being taken to any other hospital, their family would have tried every traditional remedy to stop the bleeding after they had been mutilated. Can you imagine how many girls die before they can receive help at a hospital?

Another factor is that governments are usually made up of men who view FGM as a women’s problem. And my argument for years has been that FGM does not only affect the women, but everyone, including the men and fathers. They need to question the practice because of the damage it does to their daughters, more so the complications that ensue when they choose to have a baby.

edna-1How do you want the new generation to handle this issue? Should campaign tactics change?
I wouldn’t want anybody to undo what we have been able to do for the past 40 years. Sadly though, some campaigning tactics are now having a very negative effect, with some FGM campaigners being paid to attend and to speak against the practice at conferences. We should not be earning money on the blood of our daughters.

Millions of funds are being spent on publicity, conferences, books and documentaries on raising FGM awareness. Whose awareness? The grandmothers in the villages [who do the cutting] know nothing about it and can’t read the books nor watch documentaries. The message has to come from people they know, trust and respect. People who speak their language, people whose vocabulary has not been altered. It cannot be an outsider, who when the water gets choppy, will leave.



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