It is estimated that, worldwide, more than 200 million girls and women have undergone some form of female genital mutilation/cutting (FGM/C). To mark the 16 Days of Activism against Gender-Based Violence, I want to share some of the latest news from the Population Council’s Evidence to End FGM/C research programme. This year we looked at data from women aged 15-49 in 25 countries and we found that 26 percent of women that have undergone FGM/C – totalling nearly 15 million women – report having been cut by a medical professional (medicalisation).
What is medicalisation?
As we try to end the practice of FGM/C, there has been a lot of concern over the trend of replacing traditional circumcisers with medical professionals. The World Health Organization defines medicalisation as a “situation in which FGM is practiced by any category of healthcare provider, whether in a public or private clinic, at home, or elsewhere”. Debate has raged about whether FGM/C could be carried out ‘safely’ under certain circumstances or whether all forms of the practice should be condemned.
Many countries now have bans in place on the use of government clinics and hospitals for FGM/C. On December 20, 2012, the United Nations General Assembly adopted a resolution that reflected universal agreement that FGM/C constitutes a violation of human rights, and that all countries should take action to end the practice, committed within or outside a medical institution
What do the data tell us about medicalisation of FGM/C?
Despite international consensus that FGM/C is a form of violence against women, there are still concerns that FGM/C continues to be performed by healthcare professionals, and may be getting in the way of progress towards the abandonment of FGM/C.
Based on our research, of the 15 million women who say that they were cut by a medical professional, 51 percent live in Egypt alone, and another 32 percent live in Sudan. Medicalisation rates are highest in five countries: Egypt (38 percent), Sudan (67 percent), Guinea (15 percent), Kenya (15 percent) and Nigeria (13 percent) and the rates are rising substantially in all of these countries, except Nigeria.
We looked at whether medicalisation had increased between generations and we found that in countries with substantial levels of medicalisation (over ten percent) rates are higher among daughters than mothers; the only exception is Nigeria, where rates of medicalisation among mothers and daughters are roughly equal. The trend towards increased medicalisation in daughters, as compared to mothers, is most pronounced in Egypt, where medicalisation rates among daughters (82 percent) are more than twice those among women (38 percent).
We found that in countries with substantial levels of medicalisation (over ten percent) rates are higher among daughters than mothers; the only exception is Nigeria, where rates of medicalisation among mothers and daughters are roughly equal.
We need further research to ask ‘Why does the practice persist when medicalisation is widely opposed through international and national legislation?’
We also examined which medical professionals are providing FGM/C in seven countries by putting them into two categories: 1) doctors, and 2) nurses, midwives or other health professionals. Egypt is unique in that doctors most commonly provide FGM/C. In most countries where medical personnel perform FGM/C on daughters, it is carried out by nurses, trained midwives or other trained healthcare professionals. These findings help us to better understand which people need to be targeted in interventions that aim to end FGM/C.
What is being done? An Example - Egypt
In countries where FGM/C is increasingly being performed by health personnel, the intent may have been to reduce potential health risks of what is perceived to be an unavoidable practice.
In Egypt, public policy related to medicalisation has taken many shifts over time. Egypt first developed an official policy on medicalisation of FGM/C in 1994, when the Ministry of Health permitted doctors in government hospitals to perform FGM/C. This was reversed in 1995 after women’s rights activists critiqued the policy as an endorsement of FGM/C and in 2007, further restrictions banned all state-licensed health workers in either government or private clinics from performing FGM/C.
The percentage of daughters cut by traditional practitioners has decreased steadily from 42 percent in 1995 to 18 percent in 2014 while the percentage of girls cut by health personnel increased from 55 percent in 1995 to 82 percent in 2014.
A recent “Public Statement on Combatting the Medicalization of Female Genital Mutilation (FGM) in the Arab region” was released in September this year by six professional medical bodies in Egypt, Sudan, Yemen, Somalia and Djibouti, in collaboration with the United National Population Fund and the League of Arab States. The statement starts with, “Recognizing the high prevalence of FGM and its medicalization, and realizing …. its violation of the rights of women and girls, we, in accordance with the commitment to the ethics of medical practice, support all …. programs to reduce the prevalence of the medicalization of FGM and its harmful consequences.”
What more can we do to end FGM/C?
Throughout the 16 Days of Activism, the work to end FGM/C has been highlighted in many parts of the world. We believe we can end this violation of women’s rights in one generation with robust research, commitment from governments, and the involvement of health professionals in abandonment programmes.
We believe we can end this violation of women’s rights in one generation with robust research, commitment from governments, and the involvement of health professionals in abandonment programmes.
Increasingly, we are asking health professionals to become involved in advocacy aimed at ending FGM/C. The example provided by Egypt and the Arab region highlights the importance of giving medical professionals information regarding the laws and legislation against FGM/C and its medicalisation, and the penalties of performing this harmful practice.
Increasingly, we are asking health professionals to become involved in advocacy aimed at ending FGM/C.
Professional medical bodies in Egypt, Sudan, Yemen, Somalia and Djibouti have also called for information on the medical and social consequences of FGM/C to be provided in medical schools’ curriculums and medical doctors’ on-the-job training programmes. This will raise the awareness of medical doctors, and help prevent them from performing FGM/C. It also gives healthcare professionals opportunities to engage in community awareness programs that address FGM/C, in accordance with the ethics of the medical profession and human rights.
Further studies are needed to shed light on additional issues related to the medicalisation of FGM/C.
Further studies are needed to shed light on additional issues related to the medicalisation of FGM/C. The Population Council, with partners in the Evidence to End FGM/C research consortium, has recently conducted several qualitative studies in Egypt, Kenya, Nigeria, and Sudan that complement this quantitative analysis. The research has investigated why families opt to have their daughters cut by health professionals and why health providers undertake the procedure. Reports documenting this research will be released in 2018.
What Can You Do To Stop All Forms of FGM/C?
We believe we can end FGM/C in one generation with robust research, commitment from governments, and the involvement of health professionals in abandonment programmes. More specifically:
- Medical professionals must be informed of the laws and legislation against FGM/C and its medicalisation, and the penalties of performing this harmful practice.
- Professional medical bodies need to ensure that information regarding the medical and social consequences of FGM/C are included in medical schools’ curriculums and medial doctors’ on-the-job training programmes.
- Further research is needed to better understand why the practice persists despite international and national legislation opposing medicalisation.
- Interventions and programs combatting FGM/C should be informed by high-quality research in order to bring about impactful change.
The Population Council-led research programme, Evidence to End FGM/C: Research to Help Girls and Women Thrive, is funded by the United Kingdom’s Department for International Development (DFID). The programme joins The Girl Generation and the UNFPA-UNICEF Joint Programme on FGM/C: Accelerating Change in DFID’s larger campaign to end FGM/C within one generation.