Female genital mutilation/cutting (FGM/C) made international headlines when a doctor in the United States was criminally charged for performing the procedure on multiple girls in 2017. Globally, estimates suggest that 3.6 million girls are at risk of undergoing FGM/C. Though considered a social norm in many cultures, FGM/C is widely recognized as a violation of the rights of women and girls. Most girls who undergo FGM/C are cut by traditional practitioners. But like the recent case in the United States, many girls are also now cut by health care professionals, including doctors, nurses, and midwives—a shift in practice known as medicalization of FGM/C. As we mark the International Day of the Girl Child, reflecting on the role health care providers play in the larger campaign to end FGM/C is critical.
What Are the Effects of FGM/C on Girls and Women?
Given that evidence shows FGM/C can cause excruciating pain, bleeding, and even death, it seems shocking that a health care provider would perform FGM/C on girls and women. A recent paper on medicalized FGM/C suggests anti-FGM/C campaigns that focused on the harmful health consequences of FGM/C may have inadvertently fueled the rise in medicalization. In communities where strong and pervasive social norms sustain the practice, families may have responded to campaign messages by turning to health care professionals, believing that medicalized FGM/C is safer. As one study participant in Sudan explained:
Doctors are knowledgeable and do the right thing. If doctors say to us, ‘Circumcise,’ then we will do it because if circumcision is not good they will not do it.
Yet regardless of who performs the procedure or where it takes place, FGM/C remains a violation of the rights of women and girls.
Why Do Health Care Professionals Perform FGM/C?
Recent studies identify several reasons why health professionals perform FGM/C. First, many health care providers share the same beliefs as the wider communities where they live and work. In Nigeria, for example, some providers also believe that FGM/C is necessary and cut their own daughters:
“Someone handled the cutting of my first daughter. Even we were not taught how to do circumcision where I trained. So, I learnt how to do it in 1994, when my first daughter was cut. I held my daughter for her to cut her, and I learnt it from her…”
Second, some health care professionals believe that they can make the practice safer and reduce negative health risks. As one health care provider in Kenya explained:
“…When we were doing it, we did not care about the illegality of the law because we knew that this is a procedure we were doing at the clinic and we were not advertising it. We were doing it after we’d counselled the mothers not to do it and we only went ahead with it to prevent a major risk or a major harm.”
Health care professionals’ belief that they can make FGM/C safer may stem from their own limited understanding of the health impacts of FGM/C, as very few medical and allied health training programs focus on the issue.
How Can Health Providers Become Allies in Efforts to Curb the Medicalization of FGM/C?
Research suggests that there are several ways to win health care professionals’ support as allies in FGM/C abandonment efforts:
- First, training programs for these professionals, particularly those living in areas where FGM/C is widely practiced, should focus on what FGM/C 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/C is a violation of girls’ and women’s rights to health and conflicts with the “do no harm” principle of medical practice.
- Second, these professionals, as a focus of FGM/C 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.
- Finally, health professionals’ associations and health regulatory agencies should have clear guidelines and standards for providers that outline the sanctions on those who perform FGM/C. These organizations should also offer opportunities for health care professionals to contribute to community efforts to promote the abandonment of the practice.
Reports by the Population Council’s Evidence to End FGM/C Research Consortium provide more information about the medicalization of FGM/C and the latest research to end the practice:
- The Medicalization of Female Genital Mutilation/Cutting: What Do the Data Reveal?
- Medicalisation of Female Genital Mutilation/Cutting: A Qualitative Study of Parents and Health Workers in Nigeria.
- Changes in FGM/C in Somaliland: Medical Narrative Driving Shift in Types of Cutting.
- Female Genital Mutilation/Cutting: Contentious Practices and Persistent Debates.
Two new web features outline the best available information on medicalization and the health effects of FGM/C: “Understanding the Impact of Medicalisation on Female Genital Mutilation/Cutting” and “FGM/C and Health Consequences: Implications for Policy, Advocacy, and Investment.”
PRB is a core partner on the Population Council’s Evidence to End FGM/C: Research to Help Girls and Women Thrive—a UKAID-funded research program to help end female genital mutilation/cutting (FGM/C) within one generation.