Medicalization of FGM

Various arguments are put forth by detractors of medicalisation of Female Genital Mutilation. This is a practice against which the opposition is almost unanimous as we can see through the statements of various international organisations and institutions unanimously condemning 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
• Media outlets such as The Guardian led campaign « End FGM Guardian Global Media
  Campaign »

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

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

FGM, even medicalised, remains a violation of women’s and girl’s rights (Richard F. and Decoster K., 2016). Fabienne Richard, midwife and director of GAMS Belgium, underlined 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 to FGM whether performed by traditional practitioners or 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 aiming 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 the mutilation. They are cut forever. Despite the fact that 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 from parents and communities on their bodies.”

Members have shared stories confirming this statement.

“I have among my young patients a very young 14 year-old French girl whose father is Egyptian. During holidays in Egypt, her godmother suggested she undergo surgery because “she has abundant vaginal discharges” and the girl agreed. She was cut at hospital under general anaesthesia.

When she returned she was and still is very affected by the understanding of what happened to her. I guess we make this kind of proposal to various little girls and young girls who do not understand what is really being suggested.” 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 are 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 stated:

“Medicalised symbolic incisions do not prevent extensive cutting in the future. Such a policy will fail in communities that are not convinced that the abandonment of the practice is a good idea. 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 done properly. 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 performers but the girls are then “re-excised” a second time in the village when checked by aunts or grandmothers, leading to further 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 cutting and many women, from Guinea as well as Somalia, have been cut a second time. In Somalia because the infibulation has reopened, in Guinea because the cut has been judged incomplete. Sometimes a cyst appears on the scar after the cut and some people think that the clitoris has grown again and so they cut it again. 

Teliwel Diallo, refugee in Belgium is one of the few women to openly testify of her double excision. (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 expect, you think you are going to a party, that you will eat eggs (testimonial of my last patient), but the second time it is a nightmare as they know what suffering they will be subjected to.” (Fabienne Richard, midwife)

It has not been proven that medicalisation would in fine lead to the disappearance of FGM (Kimani S, Muteshi J, Jaldesa G Population Council). On the contrary, medicalisation legitimates the practice of FGM in the public sphere by creating a “tacit approval” (Serour G., 2013) by healthcare professionals who have a strong social status within the communities (Population Reference Bureau, 2018).

A member gave 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 thta is is not the act itself that is problematic but its practice by “non professionals”. Either way, medicalisation of FGM could have contributed to creating confusion for communities and a decline in the fight against FGM.

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 performs 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 medical practices in the same way. According to her it might be important to differentiate if it’s a “symbolic” gesture performed on a girl old enough to consent for example. She wondered if “medicalised symbolic incisions prevent extensive cutting in the future”.

In their report, the Population Council raised similar questions about the association between medicalisation and the prevalence and / or abandonment of FGM/C. As the report did not find any strong correlation for or against, it concluded on the necessity to pursue studies on the topic (Population Reference Bureau, 2018).

Other members, on the contrary, remained categorical, absolutely no intermediate step in the abandonment of this abusive and dangerous practice is justified or acceptable.