Safia Ibrahim's business was in trouble. COVID-19 had taken hold in Somaliland, in the Horn of Africa. The 50-year-old widow with 10 children to support set out door to door on the capital's outskirts, a razor at hand, taking advantage of the lockdown to seek work with a question: Have your daughters been cut?
Her business is female circumcision, learned at the age of 15, performed hundreds of times and now being passed along to her daughters. She congratulates young girls upon completing the procedure: "Pray for me, I've made you a woman now."
She believes her work keeps girls pure for marriage. "This is our Somali culture. Our great-grandmothers, grandfathers — all of them used to practice," she said, even though she now knows there's no medical or even religious reason for the removal of external genitalia, which can cause excessive bleeding, problems with urination and childbirth, infections and even death. But it remains legal in Somaliland, so Ibrahim will continue until authorities tell her to stop.
Her story echoes through Muslim and other communities in a broad strip across Africa south of the Sahara, as well as some countries in Asia. In many places, COVID-19 brought stark challenges to efforts by health workers and activists to stop what they along with the United Nations and others call female genital mutilation.
Government officials, health workers and advocates say instances of FGM rose alarmingly during the pandemic in Somaliland and other parts of Africa as lockdowns kept girls out of school, making them vulnerable to "cutters" like Ibrahim, and economic pressures led impoverished parents to give their daughters in marriage, for which FGM often remains a cultural expectation, if not a demand.
In the early months of the pandemic, the U.N. Population Fund warned that disruptions to prevention programs could lead to 2 million cases over the next decade that otherwise might have been averted, and that progress toward the global goal of ending FGM by 2030 would be badly affected.
Hard data are lacking on the increase in FGM cases, but officials point to anecdotal evidence, local surveys and the observations of medical and advocacy groups. In Somaliland, an arid region that separated from Somalia three decades ago and seeks recognition as an independent country, community assessments by government workers and aid groups found that FGM rose during the six-month pandemic lockdown. Advocacy groups say they've also seen increases in Kenya, Tanzania, Sudan and Somalia.
Sadia Allin, Somalia director for the Plan International nongovernmental organization, said she was alarmed when an FGM practitioner came asking about her daughters in Somaliland's capital, Hargeisa.
"I asked her what she wanted to do with the girls. She said, 'I want to cut them,' and that was the shock of my life," Allin said. "I did not expect that something like that can happen in this age and time, because of the awareness and the work that we have been doing."
She said their survey found that 61% of residents of Hargeisa and Somaliland's second-largest city, Burao, believed that FGM was increasing under the lockdown.
Mothers give in and allow their girls to be cut, Allin said, "because the social pressure is greater than the pain."
FGM often is still performed in homes. Ibrahim demonstrated the procedure for The Associated Press in her branch-barred courtyard. Using the palm of a female translator's hand to stand as a girl's genital area, she held a syringe just above the skin and pretended to inject anesthetic — a relatively new addition to her routine.
Then, with a razor blade, she swiped at where the girl's clitoris would be. Further slashes and the labia were gone. Finally, with needles and thread, she pretended to sew up the girl's opening, leaving a small hole for urine and the menstrual blood that would begin in the years to come.
Somaliland, with a population of well over 3 million, already had the highest rate of FGM in the world before the pandemic, according to the U.N. children's agency, with 98% of girls undergoing it between ages 5 and 11. The majority undergo the most severe kind, being sewn up until marriage, as opposed to the less severe kinds where the clitoris is cut or the clitoris and labia are removed.
Thorns have been used in place of needle and thread in the most basic of such procedures in rural areas. Before marriage, some rural women are still placed on a sheet and inspected so witnesses can confirm that she has remained "sealed."
In Somaliland, COVID-19 hit as activists and officials said they were gaining momentum in securing an anti-FGM policy, a government position backed by the country's Cabinet. They call it a crucial step toward a law barring FGM for good. That would bring Somaliland in line with regional neighbors such as Djibouti or, more recently, Sudan.
The work has never been easy. Somaliland's president, Muse Bihi Abdi, has said he wants to make the practice illegal. But many religious authorities, along with others in the conservative society, have pushed back.
Some claim progress in promoting a less harsh kind of FGM, or in making sure it's performed by health workers in a medical setting. But activists say even when performed by a health worker with sterile medical tools, FGM is damaging and a violation against a minor.
The tensions were clear in the Somaliland capital on Feb. 6, when government and civil society leaders gathered to mark the International Day of Zero Tolerance for FGM, a U.N.-sponsored awareness event.
Former first lady Edna Adan Ismail — the first person in Somaliland to speak out publicly against FGM, almost five decades ago — gave a fiery speech in favor of banning the practice entirely. But the government's religious affairs minister, Abdirizak Hussein Ali Albani, would not go so far. He acknowledged that the most severe type of FGM can damage a girl's reproductive organs but said the least severe type that nicks at the clitoris should remain optional.
His comment reflected the thinking of many in Somaliland's powerful religious community, who feel they are making a concession to anti-FGM efforts.
Women are Allah's original creation and nothing in Islam says to cut them, the minister acknowledged, but he said society must also protect them. He compared the least severe type of FGM to the shaving of armpits, the pass of a blade.
Increasingly, women and some men in Somaliland's younger, more educated generation are speaking out publicly to counter such religious and cultural beliefs. Some are traumatized by their own experience and have begun to explore the relatively new practice in Somaliland of mental health counseling, even discussing the effects of FGM on sexual pleasure.
Others who speak out are health workers who have seen FGM's sometimes fatal complications — girls who bleed to death and young women who struggle to deliver their first children. Some develop fistulas, or tears that allow urine or feces to leak.
One young nurse in Hargeisa, 23-year-old Hana Ismail, was moved to write a poem about it. At the zero-tolerance event, she recited it: "I have a mark that can never be erased," she began, later describing how a knife had to be used to make way for childbirth, a life "that managed to get in."
Ismail said she speaks with every patient about the practice and the need to stop it, defying the hush around the subject that lingers even now.
Somaliland's half-light existence as an unrecognized state has complicated its pandemic response. Vaccines from the global COVAX initiative must come via the government in Somalia, which claims Somaliland but by some measures has the weakest health system in the world. Somaliland's pandemic data, too, is combined with Somalia's by the World Health Organization, though Somaliland's health ministry in December reported more than 8,300 cases and more than 580 deaths.
But now that Somaliland's COVID-19 lockdown has ended and vaccines have begun to arrive, the minister for social affairs and activists expect that the anti-FGM policy newly submitted to the Cabinet of ministers will be approved.
They hope an anti-FGM law will follow, but another challenge presents itself, one unique in Africa: Every lawmaker in Somaliland is a man.
Still, the minister for social affairs, Mustafe Godane Cali Bile, believes there is momentum. National television even aired a religious debate about the practice in recent days, giving a rare public glimpse of religious leaders who are against the practice completely.
The anti-FGM policy should be approved within weeks, the minister said, "and we're hoping the practice will be illegal by the end of the year."
Even a hard-won law, however, is expected to face backlash in a society where FGM has been part of life for generations. Ismail, the former first lady who runs a hospital in Hargeisa and put forward anti-FGM legislation two decades ago, was blunt about the fight that remains.
"It is not legislation that will stop it," she said. "Because if legislation would stop it, it would have stopped it in Sudan, and it has not. It would have stopped it in Djibouti, and it has not.
"Whatever women say, whatever we say, at the end of the day there's some imam who says, 'Oh, this is wrong.' Those few words wipe out all the efforts that have been done."
But Ismail is no longer alone as a reformer. Elsewhere in Hargeisa, women are questioning the roles society expects them to play. Shouting and laughing one recent evening, they took to a soccer field at the only sports center strictly for women in Somaliland.
The center is run by 32-year-old Amoun Aden Ismail, who recounted the challenges of having a groundbreaking tournament canceled in 2020 because the sports ministry declared it against the Islamic religion, and of being accused of wanting to turn women into men. It's not easy, she said.
She is against FGM and speaks openly about the practice with her club's members. "Some girls ask, 'How does FGM go?'" she recalled. "Some ask how normal vaginas look like." At first, the girls laughed at her explanations, accompanied by illustrations. "But I told them it's just part of life. You have to love your body, protect it."
Club member Muhubo Ibrahim, a 25-year-old health worker who plays defender, is passionate about preventing further generations of girls from being cut. "The day my mother did it to me, I said, 'I won't forgive you, forever,'" she recalled.
That didn't last, and later her mother confided, "I believe now I made a mistake." She has since encouraged Ibrahim to do what she likes with her own daughters when the time comes.