International Day of Zero Tolerance to Female Genital Mutilation

  Dissemination and implementation of the recommendations in this guideline on the prevention of female genital mutilation and clinical management of complications are crucial next steps necessary to improve the quality of health care (prevention and management) and to improve health outcomes for women and girls living with or at risk of FGM . The following actions will be taken to ensure that the guideline is disseminated and implemented. The guideline will be available in electronic and print formats. It will be translated into Arabic and French and disseminated through a broad network of international partners, including WHO country and regional offices; ministries of health; WHO collaborating centres; professional associations; other United Nations agencies, particularly UNFPA and UNICEF, who lead the UNFPA–UNICEF Joint Programme on FGM; and NGOs. In addition, a separate executive summary publication aimed at clinicians and a wide range of policy-makers and programme m...

  Strength of recommendation: Strong (moderate- to very-low-certainty evidence)  Training and providing capacity-building resources for health workers can help to improve their knowledge about FGM and its complications, their skills in managing FGM-related complications and their ability to communicate effectively about FGM prevention. Participating in effective training will help health workers respond to the needs of their clients and patients while also contributing to FGM prevention and care as part of multisectoral efforts. Assessing the impact of training and capacity-building activities on service provision for a sensitive topic like FGM requires consideration of the positionality of health workers and how their own belief systems can impact the care they provide. Health workers are a bridge between the health system and the communities they live in. Those who live in FGM-practising communities would likely understand the social norms driving the practice of FGM, and t...

  Strength of recommendation: Strong (very-low-certainty evidence) A key element of multisectoral efforts to promote FGM prevention is the creation and enforcement of national laws and policies to protect women and girls from all forms of violence, including FGM, by any person – including health workers. This is a vital component of FGM prevention as it helps to ensure adherence to human rights principles and establishes mechanisms of accountability for violating them. In addition to laws and policies, there is a need for professional codes of conduct that discourage health workers from performing FGM (i.e. medicalization of FGM), and also penalties for violating these codes of conduct. - Summary of the evidence-   The evidence review for this recommendation considered any interventions aimed at improving health workers’ access to capacity-building resources (or a combination of resources) and encouraging their direct application at the point of care. These capacity-bui...

  Strength of recommendation: Strong (very-low-certainty evidence) Individual and group health education or counselling sessions at health facilities and community-based education and awareness-raising activities targeting women and girls living with or at risk of FGM and men and boys in affected communities are aimed at increasing knowledge about FGM, promoting relevant human rights, and changing attitudes, as precursors to FGM abandonment. These interventions can be stand-alone or integrated into other education and information-sharing efforts. - Summary of the evidence - Quantitative and mixed-methods evidence reviews were conducted to inform this recommendation. The quantitative review considered interventions seeking to improve the knowledge, attitudes and health-seeking behaviour of women and girls living with or at risk of any type of FGM. The interventions included group education (in health facilities and/or outreach settings) as well as one-on-one education, information...

Strength of recommendation: Conditional (low-certainty evidence)  Deinfibulation is a surgical procedure carried out to reopen the vaginal introitus in women living with Type III FGM. In order to achieve this, a trained health worker performs an incision of the midline scar tissue that covers the vaginal introitus up to the external urethral meatus, and the clitoral glans (if present/intact). The cut edges are then sutured, which allows the vaginal introitus to remain open. This procedure is performed to improve the health and well-being of women living with Type III FGM, as well as to allow intercourse and/or to facilitate childbirth. - Summary of the evidence - The evidence review for this recommendation considered the effects of deinfibulation on obstetric, neonatal, gynaecological and sexual health outcomes, including the quality of life among women living with Type III FGM. To meet the criteria for this review, in addition to the intervention group (deinfibulation in women wi...

  Strength of recommendation: Conditional (very-low-certainty evidence) Women and girls living with FGM are more likely to have a mental health disorder, such as anxiety, depression and/or post-traumatic stress disorder (PTSD), compared with women and girls who have not undergone FGM.  - Summary of the evidence - The evidence review for this recommendation, which updated a previous review, considered whether the timing of deinfibulation, i.e. antepartum versus intrapartum, made any difference in terms of obstetric or newborn outcomes among women living with Type III FGM. Four studies were identified in the systematic review. These included a retrospective cohort study conducted in Norway by Taraldsen et al., and three studies conducted in the United Kingdom: one prospective cohort study by Bikoo et al., one non-randomized controlled study by Paliwal et al. using hospital-based controls drawn from medical records at the hospitals, and one retrospective cohort study by Albert e...