Here we share a summary, not exhaustive, of the debate that took place between 8 and 27 October 2018 on the group of the Community of Practice on FGM.
The initial questions, shared in the note of the discussion, were:
- What is your knowledge of medicalised FGM in your country?
- In your country, what arguments are used by the supporters as well as the opponents of medicalisation?
- What are the solutions to such tendencies ?
Arguments against the medicalisation of FGM
In general, all members on the list strongly condemned medicalized FGM. The main arguments against medicalized FGM, advanced by the members:
- FGM still violates the rights of children and women
- Any type of FGM, whether medicalised or not, must be rejected.
- The medicalisation of FGM can not be compared to other types of risk reduction strategies, such as needle exchange, because the child does not choose to undergo FGM.
- The medicalisation of FGM is contrary to the first principle of medical ethics, because even medicalized, they remain a violation of the fundamental rights of girls and women.
- The medicalisation of FGM does not prevent long-term health complications, as well as sexual and psychological consequences;
- Risk of aggravating the consequences, deeper cuts because performed with medical expertise and under anesthesia, not allowing girls / women to defend themselves …
- Medicalization seems to cancel all gains from efforts to abandon FGM as it normalises FGM
Member opinions and experiences
We heard experiences and practical examples in Guinea, Burkina Faso, Kenya, Mali, Mauritania, Belgium, France …
- Several members emphasized the very important role of health personnel in preventing FGM and that ministries of health should assume their responsibilities.
- Some members emphasized the importance of « arresting and prosecuting professionals, revoking licenses for clinics and hospitals ».
- Example from Mauritania of how to involve professionals: « an alliance with midwives and a lot of work with health providers has been conducted and they have even become the guarantors and actors in this fight against FGM.”
As well as collaboration with religious leaders:
“to obtain the imams’ adherence through a fatwa, we had first to have the declaration of the doctors to show that the practice harms the health of girls and women and the risk of losing their lives, which is formally forbidden by religion.”
- Training of professionals (via PLAN International) in Mali.
- France: Health professional who met « a very young girl of 14 years old, French but of Egyptian father. During the holidays in Egypt, her mother-in-law offered to be hospitalized and operated because « she had a lot of white losses », which the girl obviously accepted. She was of course excised at the hospital and under general anesthesia. She was very touched when she understood, when she came back, what had really happened to her. «
- A similar story was brought by a midwife in Belgium, a young woman from the Bohra community who suffered a medical genital mutilation in the UK. His little sister made the same trip 2 years later…
- Kenya : paper on medicalized FGM in Kenya (by Samuel Kimani and Bettina Shell-Duncan) : The rate of medicalized FGM is 14.7% (but close to 20% for the cohort of 0-14 year olds). It differs throughout the country and from one ethnic community to another.
A solution to medicalisation is urgently needed if the campaign against FGM is to bear fruit.
Why do health professionals practice FGM?
- Financial gain
- Answer to parental demand, sense of « duty to the community »
- have not deconstructed the reasons behind FGM
In general, there seems to be a lack of research on medical genital mutilation and why professionals agree to do so, even when it’s against the law.
Nigeria: « Confidence » in health workers has prompted parents to choose medicalization, according to the Population Council study.
« Almost all of the parents we interviewed had never heard of, or had experience with, FGM / C related complications. Many parents said they trusted health workers for all health-related procedures and advice and, considering FGM / C as medical procedures, felt that health workers would be well equipped to carry them out. This « trust » that parents spoke of had many dimensions. They felt that 1. health workers would be more qualified in procedure 2. could easily cope with emergencies 3. had received training to perform the procedure 4. were operating under sanitary conditions. » Population council report
Burkina Faso: Almost total absence of sensitization of health personnel belonging to communities practicing FGM and lack of information on the subject, which « thus constitutes an environment favouring the medicalization of these practices »
« ill-informed health personnel, motivated by their socio-cultural convictions or their financial gains may think that it is their duty to support a population-based demand for FGM » (doctor)
Some other issues raised during the discussion
- Existence of research that answers the question: could medicalized symbolic incisions prevent major cuts in the future?
In its report, the Population Council asks similar questions: what is the link between medicalization and the prevalence of FGM / C? What is the link between medicalization and FGM / C abandonment rates? The report concludes that they found no correlation (positive or negative) between medicalization and abandonment of female genital mutilation and that it is indeed necessary to continue the research on this subject.
- How can we deconstruct the idea in some communities that the clitoris is dangerous for the baby at birth? (ex South of Nigeria)
- What is the link between medicalised MGF and genital surgery?
- Some members, including a gynecologist from Burkina Faso, felt that medicalised FGM has nothing to do with intimate surgery. These are « adults who practice the medical procedure to reduce hypertrophic lips, we do it in gynecological surgery. The same goes for the reduction of clitoral hypertrophies. This has nothing to do with FGM in the context of Burkina Faso. »
- Others, including a Belgian midwife, shared an opposing point of view and emphasized the increasing number of intimate plastic surgeries in Europe and the fact that they are made to match to a criterion of « beauty », without there being a proven hypertrophy. According to her, there needs to be a « more holistic approach to all that is imposed on women’s bodies in all societies » that « helps to balance debates and not to see the world in black and white. in Africa, women under social pressure to match the role expected by society … and this translates first in the control of their bodies. «
- What strategies, what methods can we use to enable communities to question their beliefs about FGM, so that those who still believe that it is necessary to medicalise (in order to respect beliefs) will question the need for FGM ?
Member Research and Resources
- Figures on the medicalisation of FGM by country are also available on the UNICEF website.
- The Population Council has an ongoing research project on the medicalization of female genital mutilation. The report published in 2017 provides statistics on different countries, including Guinea Conakry, shows that the prevalence of girls circumcised by health professionals (according to their mother) is around 80% in Egypt and Sudan, 30% in Guinea Conakry , 20% in Kenya and Djibouti and also in countries such as Iraq, Yemen, Nigeria, Ghana …. THE MEDICALIZATION OF FEMALE GENITAL MUTILATION/CUTTING:WHAT DO THE DATA REVEAL?
- Specific research report on the medicalization of FGM in Nigeria. Evaluation of the health system response to the prevention of new excisions in women / girls and the management of complications of FGM / C in Nigeria (study in progress): https://www.popcouncil.org/uploads/pdfs /2018RH_NigeriaHealthSystemFGMC.pdf
- KABIRU, Caroline, Population Council, « Engaging Health Care Professionals as Allies to End FGM / C » https://www.prb.org/insight/engaging-health-care-professionals-as-allies-to-end-fgm- c / (2018)
- Inter-Office Website: Understanding the Impact of Medicalization on Female Genital Mutilation / Cutting: https://interactives.prb.org/medicalization/index.html
- Teliwel Diallo, an anti-FGM activist and refugee in Belgium, talks about her experience of re-excision (French): https://www.youtube.com/watch?v=RrPoPaZboR4