Urgent measures are needed to curtail the rising “medicalization” of female genital mutilation (FGM) and to engage health workers to prevent the practice, according to a new guideline published by the World Health Organization (WHO).

The guideline recommends professional codes of conduct that expressly prohibit health workers from performing FGM and stresses the need to train health workers to prevent the harmful practice. 

In several parts of the world, the practice is now increasingly performed by health workers. An estimated 52 million girls and women alive today were subjected to FGM by health workers –  around a quarter of all cases, according to the WHO.

The guideline offers sensitive communication approaches that can help health workers effectively decline requests to perform FGM, while informing people about its serious immediate and long-term risks, according to the WHO.

“Female genital mutilation is a severe violation of girls’ rights and critically endangers their health,” said Dr Pascale Allotey, WHO’s Director for Sexual and Reproductive Health and Research, and the United Nations’ Special Programme for Human Reproduction (HRP). 

“The health sector has an essential role in preventing FGM – health workers must be agents for change rather than perpetrators of this harmful practice, and must also provide high-quality medical care for those suffering its effects.”

Typically carried out on young girls before they reach puberty, FGM includes all procedures that remove or injure parts of the female genitalia for non-medical reasons.

Care for survivors

Over 230 million women and girls are estimated to be living with the effects of FGM. These include genital tissue damage, genitourinary tract infections, menstrual difficulties, urological complications (urinary tract infections and difficulty urinating), and sexual complications (dyspareunia and sexual dysfunction).

There is also an increased risk of obstetric complications including prolonged or obstructed labour, obstetric tears, caesarean birth, postpartum haemorrhage, episiotomy, fetal distress,, neonatal asphyxia and stillbirths. 

FGM also causes mental health disorders such as anxiety, depression, post-traumatic stress disorder [PTSD] and somatoform disorders.

Evidence shows that no matter who performs FGM, it causes harm. Some studies suggest it can even be more dangerous when performed by health workers, since it can result in deeper, more severe cuts. 

Its “medicalization” also risks unintentionally legitimizing the practice and may thereby jeopardize broader efforts to abandon the practice.

“Research shows that health workers can be influential opinion leaders in changing attitudes on FGM, and play a crucial role in its prevention,” said Christina Pallitto, Scientist at WHO and HRP, who led the development of the new guideline. 

“Engaging doctors, nurses and midwives should be a key element in FGM prevention and response, as countries seek to end the practice and protect the health of women and girls.”

Alongside effective laws and policies, the guideline highlights the need for community education and information, including community awareness-raising activities that involve men and boys. 

The guideline also includes several clinical recommendations to help ensure access to empathetic, high-quality medical care for FGM survivors. Given the extent of both short and long-term health issues that result from the practice, survivors may need a range of health services at different life stages, from mental health care to management of obstetric risks and, where appropriate, surgical repairs.

Burkina Faso has halved FGM prevalence among 15  to 19-year-olds over the past 30 years, while Sierra Leone and Ethiopia have reduced the incidence by 35% and 30% respectively, through collective action and political commitment to enforce bans and accelerate prevention.

Since 1990, the likelihood of a girl undergoing genital mutilation has decreased threefold but it remains common in 30 countries, and an estimated four million girls each year are still at risk.

Image Credits: Safe Hands for Girls, UNICEF.