Opposition to medicalisation

Various arguments are put forward by detractors of medicalisation of FGM, practice against which the opposition is almost unanimous as we can see it through the statements of various international organisations and institutions showing a common condemnation of the medicalisation of FGM. The following organisations and institutions are opposed to any form of medicalisation of FGM:

  • International institutions (WHO, UNICEF, UNFPA …)
  • Medical associations such as the International Federation of Gynaecology and
    Obstetrics (FIGO), the American College of Obstetricians and Gynaecologists
  • Inter-African Committee on Traditional Practices Affecting the Health of
    Women and Girls (IAC)
  • Numerous organisations fighting against FGM: 28toomany, GAMS Belgium,
    Equality Now …
  • Numerous African Health ministries took a stand against medicalisation:
    Egypt, Guinea, Kenya, Nigeria … as well as European governments: Austria,
    Belgium, Spain, France, Sweden, Switzerland … (28 Too Many, 2016)
  • The European network End FGM
  • Medias, such as The Guardian led campaign « End FGM Guardian Global Media
    Campaign »

During discussions, the members have underlined some elements justifying the opposition to FGM.

Medicalisation of FGM violates the first and foremost principle of medical ethics of do no harm as put forward by Doctor Souleymane Kabore.

Female Genital Mutilations, even medicalised, remain a violation of women’s and girl’s rights (Richard F. and Decoster K., 2016). In this way, Fabienne Richard, midwife and director of GAMS Belgium enhanced that:

“Permitting or promoting the medicalisation of FGM would mean denying that FGM is a violation of human and children’s rights and that it is a recognised form of gender-based violence, irrespective of the degree of harm caused or the medical qualifications of the person performing it. All forms of FGM are a violation of human rights and the right to physical, mental and psychological integrity.”

She continued stating that girls cannot consent nor to FGM realised by traditional practitioners nor by health care professionals and the effects of the practice are still irreversible

“When one compares a program for the exchange of needles for drug users, with medicalisation of FGM, I argue that this is not the same. The majority of drug users are adults or at an age when they are capable of taking a decision; usually they have, besides needle-exchange programs, access to programs to help them stop using drugs, and both choices are reversible. Girls who are cut are babies or infants, they cannot escape. They have no choice and they can’t reverse their statute. They are cut forever; even if reconstructive surgery of the clitoris is now available in some countries, it will never be the same. FGM is not an addiction that they can stop. It is an act that mutilates the bodies of girls and women, at an age when they have no say. It is an abuse of power of parents and communities on their bodies.”

Members have shared stories confirming this statement.

“I have among my young patients a very young 14 years old girl, French but whose father is Egyptian. During holydays in Egypt, her godmother proposed her to undergo a surgery because “she has abundant vaginal discharges”, what the girl agreed. She has, for sure, been cut at hospital under general anaesthesia.

She has been very affected to understand, when she came back, what happened to her. I guess we do this kind of proposal to various little girls and young girls who do not understand what it really means.” Hatem Ghada, gynaecologist, France

The participation of healthcare professionals does not in any way prevent long-term health consequences, as well as sexual and psychological consequences. On the contrary, it may even worsen the impact: deeper cuts as realized with the medical expertise and under anesthesia, under which it is impossible for girls / women to defend themselves. Furthermore, medicalised mutilations may be followed by a second mutilation done within the community when it has not been « well done ». Fabienne Richard maintained in this way:

Medicalised symbolic incisions do not prevent extensive cutting in the future. Such policy will fail in communities that are not convinced of the abandoning of the practice. For example, at the FGM clinic I attend, I see women from Guinea Conakry who have been cut twice: because the first time was not well done “ce n’était pas propre” (it was not clean). In Guinea Conakry, more than 30% of the FGM in girls (0-14y) are performed by health professionals (most of them are midwives). They cut less than the traditional circumcisers but the girls are then “re-excised” a second time in the village when checked by aunties or grandmothers, leading to double suffering. 

Where is the benefit here? To replace one practice by another without convincing the communities of the harm of the practice will not stop it.”

The question of re-excision has been debated within the members, some wondering on its truth. Fabienne Richard share her experience and the stories she heard from some Guinean women she received. Marie-Jo Bourdin related similar facts concerning women from Ivory Coast.

“During medical consultations, I ask women to tell me about their cut and many women, from Guinea as well as Somalia, “have been cut a second time”. In Somalia because the infibulation has been open, in Guinea because the cut has been judged incomplete. Sometimes a cyst appears after the cut on the scar, some think that the clitoris has grown up again.

Teliwel Diallo, refugee in Belgium is one of the scarce women to testify of her double excision face uncovered. (Human Rights Europe, 2010,)

This is not an easy topic to openly talk about as re-excision is a real trauma. The first time, you do not know what to except, they tell them they are going to a party, they will eggs (testimony of my last patient), but the second time it is a nightmare as you know by which sufferings you will go through.” (Fabienne Richard, midwife)

It has not been proven that medicalisation would in fine led to the disappearance of MGF (Kimani S, Muteshi J, Jaldesa G Population Council). On the contrary, medicalisation legitimates the practice of FMG in the public sphere when creating a « tacit approval » (Serour G., 2013), healthcare professionals possessing a respected social status within the communities (Population Reference Bureau, 2018). A member gave, thus, the example of Senegal.

“In Senegal as in many other countries where the practice is old, it can be ill-perceived by communities attached to the practice that can consider not really the act itself as bad but its practice by “non professionals”. Either way, medicalisation of FGM could have contribute to create confusion for communities and a decline in the fight.

Finally, it would be important to reinforce the communication on the fact that the aim is to eradicate this practice with all its consequences (sanitary, psychological…) no matter who realise it.’’

Nevertheless, some issues are still pending as put forward by Jasmine Abdulcadir, a swiss gynaecologist. She argued that we cannot talk of all kind of medicalisations in similar way. According to her it might be important to differentiate if it’s a “symbolic” gesture made on a girl old enough to give her consent for example. She pursued wondering if “medicalised symbolic incisions prevent extensive cutting in the future”. In their report, the Population Council raised similar issues about the association between medicalisation and prevalence and / or abandonment of FGM/C. As the report did not find any positive nor negative satisfying correlation, it concludes to the necessity to pursue studies on the topic (Population Reference Bureau, 2018). Other members, on the contrary, staid categorical, not any intermediate step in this abandonment of this abusive and dangerous practice could be justified nor supportable.

« The Community of Practice on Female Genital Mutilation » is part of the « Building Bridges between Africa and Europe to tackle FGM » project, supported by the « UNFPA-UNICEF Joint Programme on the Elimination of FGM ».
The project is coordinated by AIDOS in partnership with GAMS Belgium.

The views expressed on this website are those of the authors and do not necessarily reflect the official policy or position of the UNFPA, UNICEF or any other agency or organization.

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