Almost 4,000 women in Ireland have been genitally mutilated, yet few health professionals here know how to treat them as expectant mothers
By Sorcha Pollak
Edna Adan can vividly remember the day her body was mutilated. More than seven decades have passed since her mother and grandmother arranged for the eight-year-old to have her genitals cut, yet Adan still feels the pain.
When her father, a doctor, returned home the following day he was angry to find that his eldest daughter had been cut. “Because my father was against it, that confirmed to me that it was wrong. And if it’s wrong I shouldn’t accept that being done to others as well.
“But as a well-brought-up girl you didn’t talk about these things. You don’t want to embarrass your mother; you cannot speak about things like that. That sort of decorum and public image were very important, but that pain is real. That bleeding is real. That hurt real.”
Adan has spent four decades campaigning for an end to female genital mutilation, or FGM, both at home in Somaliland and around the world. As a midwife and nurse she has spent her career educating women about the dangers of FGM and convincing them not to subject their daughters to lifetimes of pain and discomfort.
FGM in Somaliland is still widespread; 98 per cent of women are estimated to have had the procedure, according to Unicef. More than 200 million women and girls alive today have been subjected to it.
FGM is the permanent partial or total removal of the female genitals. It is often performed on girls before they reach puberty, traditionally without an anaesthetic. The mildest form, known as a clitoridectomy, involves the partial or complete cutting of the clitoris. Type 2, known as excision, is when the clitoris and inner lips (labia minora) are cut off. In some cases the outer lips are also cut.
The most extreme form of FGM is known as infibulation: the opening of the vagina is narrowed and sealed by sewing or stapling together the two sides of the vulva. A very small single opening is left to allow urine and menstrual fluids to pass.
Nurse and midwife
Adan, who trained as a nurse and midwife in the UK in the late 1950s, arrived back home in 1961. She was used to living in a country where women were allowed to drive and could earn a salary as a nurse.
“The police at home would stop me and say, ‘You can’t drive: you’re a girl.’ It took them six months to come to terms with it, and they eventually gave me a driving licence. It took them 22 months to give me a salary as a nurse. The excuse was I was female. If I had been the cook or the laundry woman that would have been no problem. But to be a qualified nurse and a midwife, demanding a place in the civil service, that wasn’t on.”
Despite her extensive training in London, the young nurse had never encountered a patient whose genitals had been mutilated.
“I had it, but I couldn’t see myself from the other end and hadn’t had babies. The first time I looked between the legs of a woman who had FGM I thought, Oh my God, how do I get the baby out? The woman had been infibulated, and I had to learn how to do an episiotomy and open her up to get the baby out safely.”
It was 1976 before Adan had the chance to speak publicly about the dangers of FGM. As a former first lady – she was married to Mohamed Haji Ibrahim Egal, who had been prime minister of Somalia – and the first woman director of the Somali ministry of health, she was asked to speak at a women’s conference. Adan chose to talk about the most taboo topic in Somali society. Four decades later she is still talking.
“All these women went through the pain, the bleeding, the difficulty in passing urine. Most of them went through the problem of childbirth and through the cut and episiotomy. Some of them probably suffered obstetric fistula” – a hole in the birth canal. “I started talking 40 years ago, but they’re still cutting up little girls.”
In 1997, after working overseas with the World Health Organisation, Adan returned to Somaliland and cashed in her pension to build Edna Adan University Hospital. Her goal is to train 1,000 midwives for Somaliland and a million midwives from the wider continent. She says it’s the only way to reduce infant mortality in Africa.
Help where it’s needed
Although legislation against FGM is needed, what is most important is having people on the ground who can treat and educate women and their families.
“Doctors need hospitals; midwives just need a bag. There’s no point in enacting a law if you’re not going to enforce it. Talk to the women in their language, talk to them in their hut, talk to them among their families, and encourage the male population. They just push it aside as a woman’s problem. But men must take the responsibility as the fathers of these little girls who are being chopped up.”
Adan says health professionals in countries like Ireland must also prepare to treat women and expectant mothers who have been genitally mutilated. An estimated 3,780 women living in Ireland have undergone FGM, according to Akidwa, the migrant women’s network in Ireland.
“You’ve got to train midwives who will deal with these women. There may be only one or two in a blue moon, but you will be seeing them.”
Adan also says that the Government needs to outlaw the practice. “You must inform immigrants at the port of entry that if you are welcomed into this country you must understand that FGM and mutilating healthy bodies of girls is a criminal offence. I don’t want them to go away on holidays, chop up little girls and then come back. If you do not respect the laws of this country then maybe you should look for somewhere else to go. This is not a battle for only men or only women: it’s a battle for families to fight together.”
Source: The Irish Times