“I can’t wait to get back on my feet. I long to be involved with other people, laugh again and put my past behind me,” says a hopeful Bushara.
Once, Bushara held a high position in her society. But now people find her presence repulsive.
At the time of her marriage, Bushara Muhamud Ali was a poor, young girl married to a rich, young man, making her the envy of her peers.
Not long after her dream wedding, Bushara became pregnant. Her sorrow began when she had a stillbirth. Since then, Bushara has had uncontrolled urine flow.
“My smell is like a secret that I can’t hide from the world. I have tried everything, but somehow the people around me get to know,” says the young woman. Bushara and her mother have had to change houses three times since the onset of Bushara's condition.
With these unfortunate circumstances, her husband dropped out of her life. “My marriage didn’t last more than three years. He simply went away one day,” says Bushara.
“My life is nothing. Even my relatives hate me because of the stench. Whenever I enter a room, people leave or sit far from me. Some even pinch their noses when I pass near them in the streets. They all separate me; no one sits next to me. They are treating me like an outcast,” says Bushara.
“Whenever I walk in town I hear whispers warning, ‘There is the girl with the bad odor, stay away from her.’ That is why I stay at home and wait for my mother to bring my food and other necessities,” says Bushara.
The girl from a poor family has a caring mother who does casual work in order to sustain the needs of her only daughter. Bushara’s mother does laundry, washes dishes and fetches water and firewood to earn a living.
For three years her confidence has been shattered. During one of her darkest times, Bushara heard about World Vision’s advocacy against Female Genital Mutilation. She traveled from distant villages and reached Waajid Township where she met other women suffering from fistula, waiting to go to Addis Ababa for surgery. She also met women whom World Vision had helped to undergo reconstructive surgery. They are no longer suffering shame and isolation but are now advocating against female genital mutilation.
Bushara was circumcised, a condition increasing the risk of fistula occurring during childbirth.
“My mother feels guilty for ensuring I was circumcised, a possible reason for my condition. She regrets the day she dragged me to the circumciser’s home. She refers to that day as ‘The day I made the biggest mistake in my life’,” says Bushara.
Bushara’s mother, now an anti-FGM activist, also teaches other women in her society about the negative impact of FGM. Bushara is among 14 girls going to Addis Ababa to get reconstructive surgery that will help her get a new life, a life she has not enjoyed for the last few years.
“The community here is more than grateful for what World Vision is doing. Now these girls can sleep, eat, chat, walk, and even mingle with others. Their self esteem will definitely be increased," says Isha Abdulahi, the FGM advocacy team leader in Waajid.
Bushara says, “I’ll go to Addis Abba and I believe I will get healed… I’ll give my life to World Vision for saving me from isolation and shame.” Bushara now looks forward to a future with restored self-confidence.
As Tadelu Wodajo sits outside her brick schoolhouse, the 19-year-old gracefully raises her hand to shield her face from the sun. It’s hard not to notice the black tattooed spots that line her jawbone, distinctive marks of beauty and womanhood in her rural Ethiopian culture. Since she was a child, Wodajo has always desired to identify herself with her female peers.
“I forced my family to circumcise me,” she says of the rite of passage observed by women in her community. “It was only when I was in Grade 1.” Her confession is abrupt and her countenance unflinching. A brief silence, however, indicates there is more. “If I wasn’t circumcised, I would be different and they would tease me and insult me.”
Then ten years old, Wodajo persuaded her mother to invite the local circumciser to their home that Easter, the time when circumcision rituals take place in their Orthodox Christian community. Wodajo was the first of several girls to undergo the procedure that day.
Female circumcision, a euphemism used to describe Female Genital Mutilation (FGM), involves the cutting away of one or several parts of the female genitalia for cultural or non-medical reasons. Although the origin of FGM is unclear, this practice predates both Christianity and Islam and is often marked with celebrations.
Untrained traditional midwives, using no anesthetic, typically perform FGM on prepubescent girls. This causes excruciating pain and puts them at risk for infections and hemorrhaging, which can lead to shock or even death.
For those who survive the procedure, the serious health consequences become evident during childbirth. FGM is not only associated with urinary tract infections, but also prolonged and obstructed labor.
In Ethiopia, women face a one in 14 chance of dying during childbirth or from other pregnancy-related causes. Maternal mortality rates are also high across sub-Saharan Africa. UNICEF reports that one out of every 16 women will die as a result of pregnancy or childbirth, compared with one out of every 4,000 in industrialized countries.
When the United Nations presented the Millennium Development Goals in 2000, this disproportion was at the heart of its fifth goal: improve maternal health. World leaders pledged to reduce by three-quarters the maternal mortality ratio by 2015. But in countries where harmful practices like FGM compromise the reproductive health of girls, meeting this goal continues to be a challenge.
Despite international campaigns in recent years to eradicate FGM, it is practiced in more than 28 countries in Africa and in parts of the Middle East and Asia; three million girls worldwide undergo the operation each year. In Ethiopia, where 74 percent of women between the ages of 15 and 49 have experienced FGM, World Vision is working with communities to help reduce maternal deaths by raising awareness about practices like FGM that make women vulnerable to the risks.
Wodajo lives in a World Vision-supported area of Hidhabu Abote, a district northwest of Ethiopia’s capital, Addis Ababa. In her community, the tradition is to have girls undergo FGM before they reach puberty. While Wodajo asked for this procedure, she knows her widowed mother would have eventually arranged to have it done. Refusing FGM meant Wodajo would have been ostracized, reducing her chance of marrying.
Although mothers pursue FGM for their daughters, and female midwives typically perform the procedure, men with a preference for women who have undergone FGM is one of the factors that drive the culture that demands it. In many cultures, FGM is practiced to decrease a woman’s libido and prevent promiscuity.
Myths and superstitions, which vary depending on the country and region, also perpetuate this practice. “I heard people say that if a girl is not circumcised, she will have problems when she gives birth,” says Wodajo, who no longer holds this belief and now regrets having the procedure done.
In a recent study conducted by the World Health Organization, researchers found that women who had undergone FGM were more likely to suffer complications during childbirth than women who did not experience FGM. Women who had the procedure done were also more likely to need a Caesarean section, an episiotomy and an extended stay in hospital.
But in a country like Ethiopia, where nearly a quarter of the people live on less than a dollar a day, many women are unable to access the health care they need for a safe delivery. Only six percent of women in Ethiopia give birth with a skilled attendant such as a doctor or nurse present.
Rural women who live far from a health facility or can’t afford hospital fees often give birth at home with the help of a traditional birthing attendant (TBA), such as 64-year-old Gezu Dese. She’s delivered dozens of babies over the past 34 years. Like many TBAs, Dese was taught, by her mother, to perform FGM.
“When a girl is circumcised, she is considered to be a grown-up,” explains Dese, who lives near Wodajo’s community. “Now she is ready. She can marry at any time.” Closely tied to FGM, early marriage —a union in which one or both partners are under the age of 18 —is also a harmful traditional practice that is widespread in parts of Ethiopia.
Most of Wodajo’s friends who encouraged her to undergo FGM are now married. “They quit school in Grade 3,” she remembers. Premature pregnancy and motherhood are inevitable consequences of early marriage, according to UNICEF, and girls under 15 are five times more likely to die during pregnancy and childbirth than women in their 20s. “Thus a circumcised adolescent girl is doubly disadvantaged,” concludes a World Vision report on FGM, based on research conducted in Ethiopia, Kenya and Ghana.
In 2005, World Vision launched its Safe Motherhood project, which aims to increase awareness about harmful practices that affect maternal health, in Ethiopia’s Hidhabu Abote and Jeju districts. Through the project, Dese learned about the risks of FGM and how to be a more effective TBA.
Unlike some of her community members, Dese decided to stop practicing FGM. She admits, however, that she began having doubts about the procedure a few years before World Vision launched the Safe Motherhood project. What she learned through the training confirmed her suspicions.
“I used to have a lot of problems with the circumcised girls and I started to think it was not good,” Dese says of her years as a TBA. But despite her observations, she continued to practice FGM. “It is not our decision,” she says of her former views.
In 2004, Ethiopia’s government enacted a law criminalizing FGM, joining at least 16 other African countries in the legal fight against the practice. Today, forcing a woman or child to undergo FGM in Ethiopia can result in fines and imprisonment.
While laws that penalize FGM are strong deterrents, they don’t hold the promise that the practice will stop as a result. Husen Feko, a 67-year-old Muslim elder in Jeju district, southeast of Addis Ababa, is still adamant that FGM should continue. A father of 10, whose youngest daughter is four years old, Feko is not convinced that he’s alone in his belief.
That’s why Lydia Mesfin, World Vision’s advocacy coordinator in Ethiopia, is convinced that education is the key to eradicating FGM. “We have to work on the attitudes of people,” she says.
In Kenya, World Vision works with communities to establish alternative rites of passage ceremonies that are not harmful to children. In some cases, girls mark the transition into womanhood by learning about the role of women in their society. At the end of the training, the girls participate in a special ceremony to celebrate their new status.
When the Safe Motherhood project rolled out in Dese’s community two years ago, World Vision staff members held education sessions targeting community leaders. Building on previous HIV awareness campaigns, they emphasized that unsterilized blades used for FGM can also spread the virus. This, plus information about the reproductive health risks, was enough to persuade the leaders to seriously consider these issues.
With the signs of tolerance slowly dawning in her community, Dese eventually found the courage to be open about her views concerning FGM. “I told them I didn’t want to do it anymore,” asserts Dese. Although some opposed her new convictions, she adds that others in her village recently changed their views.
“As a woman, it’s a practice that we have to work very hard on,” Mesfin says of FGM. “It may take time, but people change.” In both Hidhabu Abote and Jeju districts, FGM—a subject that was once taboo to even discuss—is now being discouraged by some religious leaders, is open to debate in classrooms and is the focus of student-led drama presentations.
Wodajo participates in some of these drama skits and is now promoting awareness to her peers. “I know what happened to me and I also know these are false beliefs,” says Wodajo. “So I decided I have to teach others.”
Although many of her peers have already experienced FGM and married young, Wodajo has hope for the next generation of girls. “I want to get married and have children,” she says, but “only after I finish school and reach where I want to be.”
Ten women are heading to the Addis Ababa Women Fistula hospital for treatment of fistula cases caused by the practice of Female Genital Mutilation (FGM). As well as supporting the treatment of fistula cases, World Vision has a resource center in Waajid where girls attend school and are taught about maternal health. World Vision's Advocacy sector continues to focus on advocating against FGM through improving community attitudes and knowledge on child protection, improving livelihoods, and advocating for policy formulation and implementation.
Ten women are heading to Addis Ababa for treatment of fistula cases, which causes uncontrolled urine flow. The women range from 16 years to 35 years old and are among the many beneficiaries in Somalia whom World Vision gives hope for a fresh start.
“It is embarrassing for an adult to keep passing urine uncontrollably. I can’t go to visit friends because I fear I’ll stain their seats. People know that I have this stench so I don’t mingle a lot,” says one of the women, Lulu Hussein, a victim of fistula. This condition has brought shame, segregation and pain to the lives of these women, caused by the practice of Female Genital Mutilation (FGM).
Several years ago, walking in their shoes was Isha Ibrahim, a victim of the FGM practice. Isha was identified as suffering from fistula by World Vision and taken to the Addis Ababa Women Fistula hospital. Following reconstructive surgery courtesy of World Vision, Isha has since been healed. “Due to my smelly condition, my husband had divorced me. But since I was healed he has been appealing to take me back,” she says confidently. “I refused, the shame I went through has taught me a lesson. Society brings down people with fistula cases. I had to encourage myself and ride above the humiliation,” adds the now esteemed woman.
Early marriages and high divorce rates characterize the lives of most women in Somalia. Hadija Adden is one such woman. She was married at 15 and by 17 years of age she was already divorced. At 16, she become pregnant and had a stillbirth. Four days later, she started experiencing uncontrolled urine flow. “My husband stopped having conjugal acts with me; he said I smelled of urine all the time. He then left and I have never seen him again,” she says. “But now I am happy I am going to Addis Ababa to have the surgery and have a fresh start.”
Fatuma Abrahim's story is sadly similar. The 17-year-old was also divorced by the time she was 16 years old. Like Hadija, her divorce came soon after she started suffering from uncontrolled urine flow. “My husband left me one year ago, he remarried soon after and I was left alone. My going to Addis Ababa will be the beginning of enjoying my remaining life,” she gladly says.
Girls in Somalia undergo the Female Genital Mutilation practice between the ages of four and seven years. As well as supporting the treatment of fistula cases, World Vision has a resource center in Waajid where girls attend school and are taught about maternal health along with the normal curriculum. World Vision's Advocacy sector continues to focus on advocating against FGM through improving community attitudes and knowledge on child protection, improving livelihoods, and advocating for policy formulation and implementation.