Female Genital Mutilation (FGM) is a
global health issue. More than 200 million girls and women in Africa, Asia and
Middle East have undergone the practice, and more than 3 million girls are
annually at risk.
The impact of FGM is also spreading
further through migration to other parts of the world including Europe, the
USA, Australia and Canada.
Hence policies are needed to address
this issue in both countries of origin and countries of migration.
FGM practice is deeply rooted in a strong cultural/social
framework. It is endorsed by the practicing community & supported by loving
parents who believe that undergoing FGM is in the best interest of their
Despite its cultural importance, we need to acknowledge the
fact that FGM is a harmful traditional practice that violates the rights or
girls and women. Therefore, FGM has to
FGM has no known health benefits, and those girls and women
who have undergone the procedure are at great risk of suffering from its
complications throughout their lives.
FGM is associated with a greater risk for a
series of health complications, dependent on the extent and type of tissue
removed. Immediate health risks include pain, haemorrhage, infection, urinary
retention and injury to the urethra,
Long-term health complications include
genitourinary (urinary tract infection, bacterial vaginosis, problems with
menstruation), obstetrical (caesarean section, postpartum haemorrhage, episiotomy,
prolonged labour, tears or lacerations, instrumental delivery, difficult
labour, external maternal hospital stay, still birth and early neonatal death,
infant resuscitation at delivery) sexual (dyspareunia, no sexual desire and
reduced sexual satisfaction), and psychological (post-traumatic stress
disorder, anxiety disorder and depression) consequences.
Considering the health impact of FGM, the
World Health Organization (WHO) has played a key role in tackling the issue
from its first international conference on FGM in 1979 onwards.
In 1997, the WHO, UNICEF and UNFPA issued a
Joint Statement on FGM which described the implications of the practice for
public health and human rights and declared support for its abandonment; it was
reaffirmed in 2008. The statement
emphasized the importance of broad-based, long-term commitment as well as a
multi-sectoral approach involving education, finance, justice, women’s affairs
In 2008 and 2012 the World Health Assembly
(WHA) and the UN General Assembly respectively agreed on resolutions against
FGM urging all member states to develop, support and implement national
policies and action plans as well as to allocate sufficient resources for its
The resolutions also highlighted the
importance of incorporating clear targets and indicators in the national plans
and policies for the effective monitoring, impact assessment and coordination
of programmes. The World Health Assembly (WHA) also commits its member states
to follow up and regularly report on a set of points targeting prevention (in
particular community based interventions), legislation, guidelines and
provision of care.
No similar data is available from non-EU
countries with high numbers of migrants from FGM practicing countries, nor from
countries where FGM is traditionally practiced.
Nevertheless, a 2010 progress report on the World
Health Assembly (WHA) resolution from African member states highlights the
involvement of the health sector as an area in need for improvement. As we try
to end the practice of FGM, there has been a lot of concern over the trend of
replacing traditional circumcisers with medical professionals, otherwise known
as the medicalization of FGM.
The World Health Organization defines “medicalisation of FGM” as a “situation in which FGM is practiced by any category of healthcare provider, whether in a public or private clinic, at home, or elsewhere”.
Debate has raged about whether FGM could be
carried out ‘safely’ under certain circumstances or whether all forms of the
practice should be condemned. However, WHO has recommended that health workers
should not engage in medicalization
Many countries have banned the use of
government clinics and hospitals to perform FGM. On December 20, 2012 the
United Nations General Assembly adopted a resolution that reflected universal
agreement that FGM constitutes a violation of human rights and
that all countries should take action to end the practice, committed within or
outside a medical institution.
A recent survey looked at whether
medicalisation had increased between generations and found that in countries
with substantial levels of medicalisation (over ten percent) rates are higher
among daughters than mothers; the only exception is Nigeria, where rates of
medicalisation among mothers and daughters are roughly equal.
Research suggests that there are
several ways to win health care professionals’ support as allies in FGM abandonment
efforts. First, training programs for these professionals, particularly those
living in areas where FGM is widely practiced, should focus on what FGM is, why
it is practiced, its health impacts, and ways to prevent it, such trainings
must also sensitize health care practitioners to the fact that FGM is a
violation of girls’ and women’s rights to health and conflicts with the “do no
harm” principle of medical practice.
Second, these health professionals,
as a focus of FGM abandonment programs, should be given the opportunity to
reflect on their own beliefs and think critically about how these views may
fuel the continuation of the practice
Third, health professionals’
associations and health regulatory agencies should have clear guidelines and
standards for providers that outline the sanctions on those who perform FGM.
These organizations should also
offer opportunities for health care professionals to contribute to community efforts
to promote the abandonment of the practice.
Health Care Practitioners (HCP) can play a
key role in the prevention of FGM by providing health education to patients
and/or parents during consultations as their educational background and social
status give extra credit to their messages also, the regular interactions with
families provide them with unique opportunities to share such infor mation. Findings
show that providing health education on FGM/C to patients and/or parents during
consultations is part of HCP.
It is striking to see that the preventive
role of HCP is highly underused in countries of origin. Several studies have
identified numerous challenges to the involvement of HCP, particularly in
countries of origin, some HCP support FGM or consider it as a sensitive issue
and consequently resist working against the practice. This resistance is further aggravated by a
high workload and the lack of skills to adequately address FGM.
The WHO, however, condemns the medicalization
as it is considered a perpetuation and legitimization of a harmful practice
that counteracts efforts towards its abandonment
Another area for improvement is the systematic
use of FGM codes in medical records. Records serve many central purposes such
as providing an overview of the management of a particular disease monitoring
and improving quality of care, and providing robust databases for research.
Data on FGM/C in most medical records has so far been negligible for several
reasons including lack of codes on FGM
Finally, routines and guidelines should be
put in place to ensure the availability of FGM/C codes, particularly in
countries of origin, and their systematic use in medical records in all
At this point, I will
end the presentation to give room for questions and contributions from
participants. Thank you all for reading our tweets