malnourished little girls didn’t bleed to death from the procedure itself, they often died from resulting infections or debilitating anemia. In others, scar tissue trapped urine or menstrual fluid, causing pelvic infections. Women with scar-constricted birth canals suffered dangerous and agonizing childbirth. Sometimes the baby’s trapped head led to fatal hemorrhage or ruptured the bladder, causing seepage of urine that made the woman smell like a latrine and poisoned her later fetuses.
With antiquated equipment, each procedure took much longer than it should. The hysterectomy, a job of about an hour and a half at Syracuse Medical Center, dragged on into the night. From first incision to final, awkward suture took Dr. Abrehet almost five hours. Outside, the next case, a thirteen-year-old, waited patiently for the operation that would reconstruct her vaginal wall. The girl, a Muslim nomad, had been married at ten. Her husband’s rough intercourse had been too much for her immature body, tearing the tissue that dividesthe vagina from the rectum. The girl had run away from her husband and joined the Eritrean guerrillas. They had enrolled her, for the first time, in school, and brought her to Dr. Abrehet.
Above her green surgical mask, Dr. Abrehet’s sweaty brow bore a crudely tattooed cross. Eritrea, an England-sized wedge of land along Ethiopia’s coast, has three and a half million people divided almost equally between highland-dwelling Christians and coastal-lowland Muslims. Dr. Abrehet drew her patients from both communities. The practice of mutilating women’s genitals in Eritrea predated the arrival of both religions, and for hundreds of years neither faith had questioned it. The Eritreans’ guerrilla movement was among the few African organizations trying to wipe it out. The campaign was part of a wider agenda of promoting women’s rights that included reforming land distribution to give women a share and pressing for women’s representation in politics.
“We can’t force them, we can only teach them,” said Amina Nurhussein, one of six women elected to the Eritreans’ seventy-one-member policy-making body. Infibulation had begun to decline in the highland areas, where the predominantly Christian population saw the custom as a cultural duty rather than a religious command. But in the Muslim lowlands the issue remained extremely sensitive. As a Muslim herself, Amina understood the obstacles. “The women have been told it’s written in the Koran that they must do these things,” she said. She could tell them it wasn’t but, as an outsider and a woman, her word meant little against the word of the village sheik.
Educating the women so that they could read the Koran for themselves was the keystone in the Eritreans’ patient campaign against genital mutilation. A year before I met her, Aset Ibrahim would have told anybody who asked that clitoridectomy and infibulation were essential to a woman’s beauty and well-being. “My mother, my grandmother and my great-grandmother all told me it was right, that without it a woman wouldn’t be able to control herself, that she would end up a prostitute,” said Aset, a beautiful twenty-eight-year-old whose own genitals had been mutilated when she was about seven years old. “I even learned to believe that it looked nicer that way. We grow up reciting the saying, ‘A house isn’t beautiful without a door.’ “
As it turned out, infibulation hadn’t saved her from prostitution. Because of her beauty, Aset had been forced into servitude by the Ethiopian army, required to work as a domestic servant and sometime prostitute in a soldiers’ barracks. When the town fell to the Eritreans, the guerrillas offered Aset a chance to train for four months as a birth attendant, learning nutrition, hygiene, family planning and midwifery. Part of the course covered the dangers of genital mutilation, information that Aset now passes on to each of her patients.
Aset’s