Why FGM by medical professionals is not the answer

28 June 2018

A common misconception about female genital mutilation (FGM) is that it’s only practiced in rural and remote areas, by individuals with little formal education. However, research from the Population Council shows that at least 15 million women who have undergone FGM were cut by a health care provider, such as a doctor, midwife, or a nurse. This means a significant number of the 200 million women affected by FGM went through the practice in a medical setting. 

Why is this such a worrying trend and what can be done? We caught up with Nafissatou J. Diop, coordinator of the UNFPA-UNICEF Joint Programme on FGM, to find out more.

What drives you in your work to end FGM?

As an African woman, I am very sensitive to girls’ and women’s rights, living conditions, and wellbeing. There is no medical justification for FGM. There are so many battles to fight when you are a woman already, at least you should be free of FGM as well as other issues like staying in school and resisting sexual harassment. FGM inflicts a lifetime of effects whose costs cannot be quantified – physical pain, psychological trauma, anxiety, isolation, and despair. Where we can make a difference is ending this kind of harmful practice. 

There are so many battles to fight when you are a woman already, at least you should be free of FGM.

Tell us more about what the UN is doing to tackle this issue?

I work for the UNFPA-UNICEF Joint Programme on the elimination of FGM and our programme name is “Accelerating Change.” We were set up in 2008 and our vision is to end FGM in one generation. This was based on research we conducted in the year 2000, which estimated that by bringing in the social norm perspective, we could really declare the end of FGM in the next 25 years.

Why is the medicalisation of FGM so important to confront? 

The medicalisation of FGM is really worrying for us. Activists put a lot of focus on communicating the health consequences of FGM, and today we have a total of over 15 million girls who have undergone FGM by health care providers. Of course, the health consequences of FGM are what brought more attention to the issue and advancement in terms of policy and dialogue with traditional and religious gatekeepers. It’s an easier entry point and area of discussion, but the reaction from the communities when you tell them FGM is harmful is to say, “Ok, let me find a safer way to do it.” They understand that the process is harmful, so they turn to a health care provider with hygienic tools. The reality is, FGM can never be safe and there is no medical justification for it. Even when the procedure is performed in a sterile environment by a health care provider, there is a risk of health consequences immediately and later in life.

The reality is, FGM can never be safe and there is no medical justification for it.

Medicalised FGM is happening in several countries (seven in Africa) and in other parts of the world, like Iraq, Indonesia, and Malaysia. Health care providers are influential people because they save lives – so the minute they start doing FGM, it legitimises the practice. For example, in Sudan and Guinea it’s the midwives doing it (FGM), and these are women who protect other women and newborn babies during pregnancy and birth. This doesn’t change the fact that FGM is a form of abuse, a human rights violation against the bodily integrity of the girl, and done without her consent.

So, medicalisation is dangerous because it risks legitimising FGM, which is always a human rights violation. What is being done to address this?

Right now, the big question is how to make sure health care providers respect the Hippocratic Oath to do no harm. They can be agents of change, so we need to make sure that they are engaged, able to resist social pressure, protect girls, and help shift the norms in a collective way.

Health care providers have great potential to use their voices to support the global movement in ending FGM. We support countries in developing national guidelines to address medicalisation. In medical schools, there used to be no mention of FGM, but we have been able to include it in the curriculum in some countries, as well as training modules for in-service professionals. We also support the dissemination of laws and their enforcement. Usually, the law is more severe in terms of sanctions when it is a health care provider doing it. So, this information needs to be out there, widely known by everyone in the medical community. Professionals coming out of medical school will leave with that knowledge, but more than that, also the attitude of condemning the practice.

We have also started putting in place monitoring, evaluation and accountability mechanisms to identify these cases, track them and report them to the judicial system. We need to strengthen our engagement with national human rights institutions to carry out inquiries.

Nafissatou J. Diop with proud women who ended FGM in their community in Afar, Ethiopia

What advice do you have for those working to end FGM?

Be courageous. Don’t be afraid. Be strong in your vision, in your commitment, in your conviction that FGM should end. There is also a need to question the approaches and strengthen evidence-based interventions. I’ve been working on this issue for 20 years and the changes are coming very fast now.

I’ve been working on this issue for 20 years and the changes are coming very fast now.

However, not everybody is a messenger. Ending FGM is important, but the messenger is even more important. Who is bringing the message is key. I have seen this kind of mistake so many times and it can be so harmful when the wrong person, from outside a community, brings messages to religious leaders, for example. This, for me, is a key element. Change needs to come from within. We need to prioritise a culturally sensitive approach, and focus on empowering people within these communities to help them spread the norm of not cutting their girls. 

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