Medicalization of FGM.

 

The medicalization of FGM refers to situations in which the procedure (including reinfibulation) is performed by any category of health worker, whether in a public or a private clinic, at home or elsewhere, at any point in time in a girl’s or woman’s life. Communities may be increasingly turning to health workers to perform the practice for a combination of reasons, with the most recent estimates indicating that some 52 million women and girls alive today were subjected to FGM by a health worker (32). There is concern that attention to the health complications of FGM conducted by traditional practitioners could inadvertently result in an increase in the medicalization of FGM in some settings, as a response intended to reduce the health risks while continuing the practice. There is evidence that rates of medicalized FGM are on the rise. Efforts to stop medicalization were initiated by WHO’s Regional Office for the Eastern Mediterranean in 1979 at the first international conference on FGM, which took the form of a seminar held in Khartoum, Sudan, on traditional practices affecting the health of women and children. The aim of the seminar was to exchange information, in particular on FGM within the region, and to respond to this information. Later, in 1997, WHO, the United Nations Children's Fund (UNICEF) and the United Nations Population Fund (UNFPA) published a joint statement on FGM stating that FGM was “universally unacceptable because it is an infringement on the physical and psychosexual integrity of women and girls and is a form of violence against them” and also that the role of WHO, UNICEF and UNFPA was “to support global, national and community efforts for the elimination of female genital mutilation in order to achieve health and well-being for women, girls, their families and communities”. The document also established WHO’s position against the medicalization of FGM, stating that “WHO has consistently and unequivocally advised that female genital mutilation in any form should not be practised by health professionals in any setting”, emphasizing that medicalization of the procedure does not eliminate the harm of FGM, and that “medicalization is also inappropriate as it reinforces the continuation of the practice by seeming to legitimize it”. The opposition to the medicalization of FGM was reaffirmed in the 2008 interagency statement Eliminating female genital mutilation.

The following definition was adopted in the 2010 Global strategy to stop health-care providers from performing female genital mutilation: “Medicalization of FGM refers to situations in which FGM is practised by any category of health-care provider, whether in a public or a private clinic, at home or elsewhere. It also includes the procedure of reinfibulation at any point in time in a woman’s life”. Both the interagency statement and the global strategy strongly emphasize that regardless of whether FGM is carried out by traditional practitioners or medical personnel, it represents a harmful and unethical practice, with no health benefits, which should not be performed under any circumstances. Numerous health worker professional associations, United Nations agencies, NGOs and governments have endorsed the stance of “zero tolerance” towards FGM. It has been recognized that stopping the medicalization of FGM is an essential component of the holistic, human-rights-based approach to the elimination of the practice. On this basis, the 2010 global strategy serves as a foundation for action to stop the medicalization of FGM. The strategy includes four pillars of action countries should take to end the practice (34). These include building political will, training health workers, establishing legislative frameworks to ensure accountability, and strengthening monitoring and evaluation initiatives. WHO and its partners have been supporting countries to develop and implement national plans for the health sector, which are structured around these four pillars of action. These plans include the creation of protocols, manuals and guidelines to guide health workers in dealing with requests from parents or family members to perform FGM on girls, or requests from women with Type III FGM to undergo reinfibulation after giving birth. One element of the national plans for the health sector requires working directly with health workers to build their knowledge, to clarify their beliefs and strengthen their skills to refuse requests and advocate against FGM. The credibility of health workers and the respect afforded to them by the communities they serve enable them to influence the opinions, attitudes, beliefs, motivations and behaviours of their clients and patients. With focused support and training, their engagement can further encourage abandonment of FGM, in conjunction with the efforts of professionals in other sectors (e.g. social, protection, legal and education). Technical knowledge about how to recognize and manage the complications of FGM, including obstetric care, and how to counsel women and girls on FGM-related issues, must be provided in order to emphasize and strengten caregivers rather than perpetrators of a harmful practice.