Nour, Nawal M.
Nawal M. Nour
Dr. Nawal M. Nour established the first, and to date only, hospital center in the United States devoted to the medical needs of African women who have undergone female genital cutting (FGC), also known as female circumcision. Nour helped to develop a surgical procedure that can help alleviate some of the negative effects of FGC, such as urinary tract infections, painful menstrual periods, painful sexual intercourse, and difficulty conceiving and giving birth.
A secular Muslim who was born in Sudan in the mid-1960s, raised in Egypt, and educated in London and the United States, Nour has worked extensively to promote understanding of FGC among doctors in the United States and Canada. Her goal is to enable physicians to treat affected women without prejudice. She has been praised by patients and colleagues for her sensitivity to her patients' emotional and cultural concerns, and in 2003 received a prestigious MacArthur Fellowship grant in recognition of her contributions to healthcare for African women immigrants.
Family Emphasized Education for Girls
Nour did not experience a typical childhood for a Muslim African girl. She was one of four children born to an American mother and a Sudanese father who had met as students in London. Nour's father served as Sudan's minister of agriculture, and her mother, a native of Rochester, New York, became a professor of plant pathology at the University of Khartoum. Dr. Nour and her siblings grew up in Sudan and in Egypt, where her parents sometimes took the family horseback riding around the ancient pyramids at sunset. When Nour moved back to Sudan at age 12, she was surprised that her friends there led such sheltered lives compared to the freedom she was used to, since her parents allowed her to attend parties, go on trips, and enjoy other activities. They also emphasized education, especially for their daughters, insisting that it would free them from cultural expectations that could oppress women.
By the time the family moved to London when Nour was 14, she had become seriously interested in issues relating to women's freedom. In Khartoum, she had heard her friends talk about FGC but did not know much about it except that girls looked forward to it as a rite of passage. In London, however, where she attended the American School, she was introduced to feminist writers like Simone de Beauvoir. She also read The Hidden Face of Eve, Egyptian doctor Nawal El Saadawi's account of her own forced genital cutting at age six. Responding to the pain, betrayal, and outrage that El Saadawi conveyed in the book, Nour began to question the procedure, discovering how deeply it could scar women both physically and emotionally. "It hit me to the core," she told Dick Gordon in an interview on The Connection for National Public Radio, "that we need to find ways to stop this practice." She wrote a paper on the subject in high school and another in college. As she commented to Boston Globe writer Irene Sege, "I guess it was something that was a constant thread throughout my life."
After high school, Nour moved to the United States to attend Brown University, writing her senior thesis on "The Emancipation of the Egyptian Woman." Originally thinking she would pursue a career in international development, she worked as an intern at the United Nations for a year. But she grew frustrated by the bureaucracy she saw around her, and decided that she could be more effective—and see faster results—as a physician. She went on to attend Harvard Medical School, earning her M.D. in 1994. After completing her residency in obstetrics and gynecology at Brigham and Women's Hospital, a Harvard teaching hospital in Boston, Nour earned an M.P.H. from Harvard School of Public Health.
Reached Out to African Immigrant Patients
During her residency, Nour began to do outreach work among Boston's African immigrant population. She found that these women wanted a clinic of their own, and received permission from the Brigham and Women's Hospital to open the African Women's Health Center there in 1999. Oddly enough, though, when Nour first opened the clinic, no one came. Patients thought she wanted to benefit financially from them, and therefore stayed away. Only after she assured them that she was on salary from Harvard and therefore had no financial interest in acquiring new patients did they begin to turn up in her examining rooms. Since 1999 the clinic has increased from 8 to 10 patients per session to 15 to 20 patients per session, and Nour has found herself increasingly in demand. "She understands me when I talk to her," one Somalian woman, quoted in a New York Times piece by Teresa Burney, said of Dr. Nour. "I am comfortable here."
Nour's patients include many women from Somalia and Ethiopia, where the prevalence of FGC is as high as 98 percent and 90 percent, respectively. The practice of genital cutting, which is traditional in many Muslim areas of Africa but has nothing to do with Islam, can take various forms. Some FGC practitioners remove a small portion of the female genitalia—others take more. When the cutting is finished, the practitioner concludes by suturing the remaining flesh together, which leaves only a tiny opening for urination and menstruation. Performed without anesthesia and often under unsanitary conditions by people without medical training, FGC can lead to serious infection and even death. Girls who survive the procedure often live with pain and recurrent infections.
Nour quickly became known among African immigrant woman as a doctor who would understand their health needs and not react in horror to their mutilated or excised genitals, as unprepared American doctors sometimes did. "The fact is," Nour explained in a New York Times interview with Claudia Dreifus, the patient "may or may not have a problem with how her body looks, but she doesn't want to be judged…. I understand that female circumcision is a horrible act and I empathize with the horror of the doctor, but what I ask is that a physician not reveal their emotions and thoughts to the patient." For this reason, Nour insists on using the word "cutting" rather than the more judgmental term "mutilation" when describing the practice. What her patients need, she emphasized in Burney's New York Times article, is not pity but respect.
At a Glance …
Born in Khartoum, Sudan, Africa, in the mid-1960s; married. Education: Brown University, BA, 1988; Harvard Medical School, MD, 1994; Harvard School of Public Health, MPH, 1999. Religion: Muslim.
Career: Brigham and Women's Hospital, Boston, MA, director, Obstetric Resident Practice, and founder and director, African Women's Health Center, 1999–; Harvard Medical School, Boston, MA, assistant professor.
Awards: Commonwealth Fund/Harvard University Fellowship in Health Policy; Brigham and Women's Hospital, H. Richard Nesson Fellowship; MacArthur Foundation Fellowship, 2003.
Addresses: Office—Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Urged Cultural Sensitivity about FGC
Elaborating on this theme in her interview with Dick Gordon, Nour said that most of her patients consider FGC "very routine" and that cultural sensitivity is crucial in efforts to stop the practice. Westerners, she said, must learn about cultures that practice FGC before they step in to try to ban it. While acknowledg-ing that patriarchal oppression can play a role in the perpetuation of the practice, she noted that women themselves often support it. "Most parents circumcise their daughters because they love them," she explained, for if girls do not undergo FGC, they are considered unmarriageable in their cultures. Simply condemning the practice, therefore, would send an inappropriate message of blame. A better approach, as she explained to Gordon, would be to help create conditions that will stop FGC "from within, not from without."
In 2003, Nour received an invitation to participate in fashion designer Eileen Fisher's "Women Change the World Every Day" campaign, which featured photographs of American women who are leaders in their fields. At first Nour wanted to decline, but her father helped change her mind. She told Boston Globe writer Shari Rudavsky that the experience proved more rewarding than she had expected. She received numerous emails from women who had seen her photograph, including one from a fellow doctor and mother of two who had been having doubts about whether to complete her own medical training. Nour also enjoyed meeting the campaign's other models. "She's an incredibly lovely person," the campaign's director told Rudavsky, with "this tremendous willingness to connect to the other women and curiosity about so many things."
Later that year, Nour was honored with a MacArthur Foundation fellowship worth $500,000. Jokingly, her coworkers put a sign on her office door reading "Quiet! Genius at work." Emphasizing that the award recognizes creativity, not genius, Nour explained to Irene Sege in the Boston Globe that she hoped her newfound celebrity as a MacArthur grant recipient would "give me the leverage to get even more funding" for her work. Noting that her friends hoped she might use some of her grant money to replace her beat-up old car, Nour told a writer for U.S. News & World Report that once you've lived in a developing country, "you don't end up needing a lot of things." The money, she added, should be used for good work. Talking about the MacArthur award on The Connection, Nour said that her next step would be to continue her work in Africa. There are impressive grass-roots organizations there that are working to stop FGC, she said, and that could benefit tremendously from Western collaboration or funding. In time, she believes, the practice will be eliminated. "There are days when I feel so fulfilled," she told Dreifus. "When women come to me and tell me that their pain is gone, when they say 'I didn't realize that sex didn't have to be painful,' or they say 'I had so much fear about delivering my baby and it turned out to be so easy.' Those are certain things I feel really great about."
Black Issues in Higher Education, November 6, 2003, p. 10.
Boston Globe, May 25, 2003, p. 4; December 9, 2003, p. D1; February 6, 2005, p. 16.
Essence, February 2004, p. 34.
Money, July 1, 2004, p. 44.
New York Times, July 11, 2000; June 6, 2004.
O! The Oprah Magazine, February 2002, p. 141.
U.S. News & World Report, October 13, 2003, p. 13.
"African Women's Health Center: Director's Bio," Brigham and Women's Hospital, www.brigha-mandwomens.org/africanwomenscenter/bio.asp (October 26, 2005).
"MacArthur Fellow Dr. Nawal Nour," interview with Dick Gordon, The Connection, National Public Radio, October 15, 2003.
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