A Discussion with Edna Adan Ismail, Director and Founder of the Edna Adan Maternity Hospital in Hargeisa, Somaliland

With: Edna Adan Ismail Berkley Center Profile

July 8, 2013

Background: Edna Adan Ismail and Katherine Marshall spoke in Libreville, Gabon on the margins of a conference honoring the centennial of Albert Schweitzer’s mission to Central Africa. Edna Adan Ismail is a leading global advocate for women’s rights and especially for action to end harmful practices like female genital mutilation (FGM). She also has built from scratch a superb hospital that serves women in Somaliland as well as those from neighboring countries in the Horn of Africa. This conversation focuses on an issue she has put at the center of her advocacy and practical work: ending female genital circumcision (FGC). She describes the circumstances that turned her into a champion for women’s rights and gave her the courage and inspiration to speak out on a subject that is taboo. She argues that it is vital to engage both men and religious leaders. Edna Adan Ismail is a Muslim and proud of her faith. She draws on her faith and values as she engages intelligently with religious leaders and the religious and cultural beliefs that account for the persistence of FGC in Somaliland and elsewhere. But she speaks forcefully for what she sees as the true meaning of religion: respect and leading a life guided by values and caring for others, in contrast to a focus on rituals and rigid beliefs.

Turning the clock back, what inspired you to become a passionate advocate for the cause of ending FGC?

Looking back, I became an advocate because I am a woman and I was myself affected by FGC. And from that very moment, as a child, I felt that it was unjust.

I was 8 years old. On the day of the operation, my father (who was a very prominent doctor and respected leader in our country, often referred to as the father of health care in Somaliland) was out of town. When he came back it was over. He was angry, and it was the first time that I had felt that kind of tension, loud voices and the agony of my father, crying out that it should not have been done to me. That planted the seeds of my sense of injustice, and started the embryo that led me much later to act.

I was a well brought up Somali girl, who learned what to say, what not to say, and who to say it to. Never would I have mentioned a women’s reproductive organs. They were never named and their nature or purpose were never discussed. I never considered asking or talking on the subject. But I became a midwife and I spent every day getting babies out from precisely that area. Even then the words were not used and the organs were not mentioned. They had no name. But I was touching them, sewing them up, cutting, and dealing with the passage of the baby, all the time. The organs gave me information about where the baby was lying and his or her condition. And the difficulties that I saw women facing gave me a revulsion. I saw the problems that were the result of female genital circumcision, had to do extensive episiotomies, saw the pain that women faced. The sense of wrong built up over time.

I did not think consciously about this experience as it unfolded. I did not have a sense that I was building up information, that I would talk about it one day. But it was like a volcano, rumbling deep down, and I had no idea when and how it would erupt.

The turning point came in 1976. I was the director in the ministry of health in Somalia, the only woman and the first to have been appointed to any position of authority (Somaliland was part of Somalia at the time, separated in 1991).

There was an international congress in Sudan on obstretics and gynocology and I was invited to attend, with two male colleagues who were obstetricians. I was head of the delegation, as director. We sat in this large congress, with hundreds of people, hearing many presentations. There were doctors, officials, religious leaders, some men in turbans, women in burkas, and so forth.

A medical professional started to give a presentation on the practices of FGM. He spoke about the differences women faced with and without FGC, the complications it caused, etc. I was embarrassed that the topic was even mentioned, but looked around at all the others in the audience and saw that they were watching, including graphic pictures projected, with no embarrassment. They were all interested in the topic. I realized that this was a topic that can be mentioned and described, by a Muslim, and that there was community interested in it. The presenter was describing the practice in a very medical way. It was like measles or whooping cough.

And I thought, my God, this is indeed a problem. I did not know then when or how or where I would use this information. But I was struck that my Somali colleagues were not embarrassed.

It was a few weeks later that the minister of health called me in. There was to be an inauguration of the Somali Women’s Health Association. Routinely officers of the ministry went to events like this one, but this meeting drew people from all the regions. The minister of health told me that because I was a woman I would represent the ministry there. What would I speak about, he asked. He expected the usual sort of answer, a policy issue that we were working on like vaccination or breast feeding. But, he said, he would leave the decision to me. Quite suddenly it came to me, and I said I would speak about female circumcision.

The minister jumped back. He said that I could not talk about such a subject. I should pick a subject that was less controversial. But I stuck to my position: if you want me to speak there, this is what I will speak about. He tried to talk me out of it, suggesting that I talk instead about something that was a normal ministry topic. But the skeleton was out of my closet and I had no intention of putting it back in, so I stuck to my ground. He told me to present a draft of what I would say, in written form, to him.

So, guided by the presentation I had heard so recently in Sudan, I wrote out my talk. My main argument was that Islam did not require the practice of FGC and that it ought to be viewed as a problem to be addressed and brought to an end. I brought the draft to the minister. He was getting into his car at that moment, on his way to see the president, Muhammed Siad Barre (who, by the by, threw me behind bars several times). The minister took my paper. I knew that he would want to get the president’s clearance on a topic like this. He said he could get back to me. And a couple of hours later I got a call from the minister, saying that it was fine, it would be good for me to talk on the subject.

I knew this was too easy. He must have talked to the president. And what they were expecting was that speaking on the subject would reverberate on me, that people would throw shoes and stones at me and embarrass me. That indeed is what they wanted.

But I thanked him and went ahead. I told the minister, however, that when I gave my presentation he would be there. No, he said, I was to represent the ministry. Yes, I replied. If I am representing the ministry and government you must be there, as the minister of health. If you are not there, I said, I will talk about something innocuous like measles. You are the minister for every part of the body. Since the minister had promised Siad Barre that I would discuss the topic he had to be there. At first he said he would come just for the opening, but I said that if he left before I spoke I would talk about whooping cough. He agreed to be there.

The next day, as we arrived at the place where the inauguration was to take place, there were police with riot helmets outside. The minister and his colleagues were convinced that the women would react violently and throw shoes at me. The minister was agitated and sweaty.

The time came for me to speak. There was a sea of women’s faces before me. I began in a casual way, in an easy conversation with the audience. I told them how happy I was to be with them, how they came from all parts of the country, that they were community leaders, that we depended on women to progress, and for the good health of communities. They had listened to me and supported me over many years. At first there was a sense of fear that separated us. When we first came to vaccinate, the women hid their children, because they were afraid. But now when the vaccinators come they queue up because they understand that it does good. Both they and I listened to each other over the years and took advice.

And now, I continued, I wanted to talk about something we had to do together. They responded with agitation, thinking I would speak about some dread new disease. I said that I wanted to talk about the health problems associated with female circumcision.

The heads and eyes went down. The women were shocked. I said, yes, I am also shocked, but as much as I am shocked and was ashamed to speak about this topic, we need to discuss it. And I went through the health problems that were the result, bleeding, pain, infection, and so on. The heads slowly came up. Their interest was caught. I looked at their eyes. We went through all the problems linked to FGC and heads nodded. I stuck to the medical issues. And I said that I remembered well when it happened to me, and was sure that they did also.

I finished by saying that I would like to hear from them what they thought. I was sure that there were women who were older and wiser than me, and wanted to have their experience, to fill in the gaps of knowledge.

An old woman got up. A very old woman. She tottered to the front of the room, and opened up her robe. She took off the covering from the hair, saying it was the first time she had done that in public since she was married. She wanted to show that her hair was white so that everyone would know how old she was. She gave a detailed description of the complications she had suffered when she was circumcised. She saved the day, and the tension faded in the room.

I said there were so many hands that we needed to break, have coffee, and allow the minster to leave and return to his work. Then the group would divide by regions, and talk about their experience. Each group would chose someone to speak for them, and each person could thus give their opinion, and say whether we should work together for solutions.

That was in March, 1976. I have never looked back from that moment.

What happened next?

We moved forward steadily from that moment on. We formed committees, passed legislation, etc.

But from 1988 on the civil war in my country (both Somalia and Somaliland) disrupted everything we were doing and had done. There were millions of refugees. People fled to Somaliland, Kenya and Ethiopia. During the years of conflict we were stuck. People could think of little else besides survival during those years: how to eat and to stay alive, to find shelter, to avoid landmines.

And I was forced to leave the country.

You worked with the United Nations during those years?

I took up the cause in other countries during that terrible period, working mainly through the United Nations and especially the World Health Organisation (WHO).

In 1987 WHO invited me to introduce the subject of FGC in Djiouti. There was resistance to efforts to end the practice from the then First Lady there. It was very much the same culture as my country, and so I was able to communicate with her. The visit was very successful. So I worked in Djibouti through 1991, as the WHO representative. We did a lot of work. Law 555 was passed, outlawing FGC and infibulation. In 1996 I was sent to Somaliland by the WHO to relaunch the campaign against FGC. My ex-husband had become the president of Somaliland so that helped in launching the campaign and introducing the subject.

Are you now back in Somaliland? What is happening on FGC there today?

Yes, I have worked from Somaliland since 1997. Today, anyone can speak about the subject. If someone opposes FGC they can say so and if they support it the same is true.

But I felt that we needed to know where we stood. So we did a survey a few years ago, a careful audit, of 4,000 women. We did it in the best place to find out what is happening: prenatal checkups. That’s a natural place to examine women and we could find out exactly where we stood. You really can’t find out any other way. We had generous support from the Norwegian government to do the survey, and from an anonymous Norwegian donor to publish the report. The survey is available online here.

We were horrified to learn from the survey that 97 percent of the women we examined had experienced FGC, despite all the years we had been discussing the issue.

How do you explain the high level?

The only way that I can explain it is in terms of the violence that gripped my country and the fact that most people had lived for years in refugee camps, since 2002-3. As refugees there was a constant fear of rape of girls. People thought that infibulation would be a sort of contingency plan so that girls would not be raped. It is the only explanation I can give. The women who were having babies now were probably the women who had been taken to refugee camps as young girls, or who were born out there.

So what happened next?

We reinitiated and reinstated the campaign. I was then minister of social affairs and we had an active campaign to eliminate FGC in Somaliland. But we still need to find the resources to do another survey so we know where we stand: where we are doing worse and better, and how much in either direction. We need the data to survey the next 4,000. And we need a strategy that is a little more aggressive. We need to develop it together at the national level.

But to make sure that we are not hitting our heads against the wall constantly, I am absolutely convinced today that we must involve men. They must be part of the discussion and of the solution.

We also need to talk to religious leaders. That is to make absolutely clear that FGC is NOT, underscore NOT, a religious requirement. Circumcision is a requirement for men, but not for women. Circumcision is optional for women but infibulation is forbidden by Islam.

What is the position of religious leaders in Somaliland on this question?

Some are for and some are against circumcision of girls. There is division.

When I was with the WHO in Djibouti I had resources. What I did there was to select three to four hard liners and perhaps one leader who stood in the middle. I arranged study tours, to Tunisia (where they speak French also), to Al Azhar in Egypt, and to Saudi Arabia, doing the Haj. They were able to talk to theologians, so they did not have to take my word for it. That’s how I was able to convince them that indeed FGC was not in any way required by Islamic teachings. It was very successful. Unfortunately I do not have the resources now to do that in my own country.

What do you think will work and what will not?

I am absolutely convinced now that premature legislation will not work.

In Sudan, there has been legislation outlawing FGC since 1947 and they still chop little girls. If you cannot enforce don’t legislate. It only devalues your legal instruments. You need to be realistic. You can’t put every mother and grandmother in jail. There are not enough jails in the country.

So the right route is through constant education. When only a few are still practicing FGC that is the time to pass a law. But not when there is no way of enforcing it.

The other danger is that premature legislation forces the practice underground. There are plenty of women who say in public they have put down the knife and stopped the practice. But FGC is still very much there.

Your mother circumcised you but your father was angry. What was their motivation? Did they ever say anything to you?

It was never discussed. They never told me anything. That is the common practice, and girls never know why this has happened.

I believe that for my mother and for others it is seen as a way to purify the daughter. It is also seen as a kind of chastity belt. Further, the act of circumcision is a time of celebration. Women from the community are invited to witness the cutting. Neighbors know it has happened. In some ways it is like a baptism, where your closest friends come. Prominent women come. A sheep is slaughtered, and there is a day of celebration. People will say to me, even now that I am 75, “I was there on the day of your circumcision.” My family was prominent so there was even a sense of nobless oblige. The daughters of Dr. Adan had to be circumcised as a social gesture, for the status of the family. It’s deep in the culture and the motivations are complicated.

A comment I have heard is that you can’t leave your girl open: it is like leaving the door to your house open when you sleep, for anyone to enter.

For me to witness this contrast between the sense of celebration and my father’s anger was unforgettable and it made a huge impression on me. It was a true eye opener: the pain, the unhappiness, and the rage he felt.

How do you live your religious and Islamic values in light of the tensions you point to? How do women deal with the contrast of happiness and pain?

My father was a very devout Muslim also. He was very much respected in the community. But I realized that he opposed the practice of FGC with force and passion. The practice had nothing to do with religious beliefs.

I am a good Muslim also. But for me religion is not about rituals. It is about how you live your religion. It is about kindness and charity, living a clean and honest life. I live my religion through my acts, through the way I work with poor people, students, patients, and colleagues. It is not about being traditional. I do not dress in a traditional way; my neck is not covered. But I am far more religious in my behavior than many people who say they live entirely by their religious beliefs. Being true to any religion is about how you live, how you respect the rules of God, how you live with others. It is a respect that safeguards others, that respects life and the property and dignity of others. It is doing unto others what you would have them do unto you. It is about going that extra mile to help others and to love them. I feel that I am being guided to the kind of life I lead. My bank account may be empty but I feel that my bank account upstairs is full.

What has made you such a strong advocate?

I needed to share the struggle with others. I also came to realize that this is a long, long-term struggle, that needs persistence and patience. I needed partners in what I was preaching. I needed a bigger voice to address the challenges I could not address alone. There is no single way to defeat the problem, no simple recipe.

This kind of struggle is about true values. One’s values are not static. They change and develop with different circumstances and different stages of life. They become more complex and subtle with age. Priorities must be different when you face career challenges, being a mother, a friend. I know that I have had far more privileges than most African women. I have been up there with the elite and I have suffered, I have had education and many privileges and opportunities. That gives me a special responsibility to act. And I am now 75, and what I see is the need to bring younger people into the light so that they can act.

Because a problem is difficult, you must deal with it. And because it takes a long time you must stick to it, constantly. That is the way we can bring about change. That is the case for female genital circumcision. And it is also the case for women achieving true equality in this society, as in others. As Leymah Gobowee reminded us here in Libreville, girls are not there just to make babies and to do chores. If we educate girls we will be a long way along the road. But we need to start with a simple willingness to talk to women, to hear them, and to deal with them round the clock.

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