KUALA LUMPUR, April 29 – Urgent measures are needed to curtail the rising “medicalisation” of female genital mutilation (FGM) and to engage health workers to prevent the practice, according to a new guideline published today by the World Health Organization (WHO).
While the health sector plays a key role in stopping FGM and supporting survivors, in several parts of the world, evidence suggests the practice is now increasingly performed by health workers.
As of 2020, an estimated 52 million girls and women were subjected to FGM at the hands of health workers–around one in four cases.
The new WHO guideline, titled The Prevention of Female Genital Mutilation and Clinical Management of Complications, provides recommendations to both prevent the practice and ensure evidence-based care for survivors, covering actions for the health sector, governments, and affected communities.
“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), in a statement.
“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. 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 “medicalisation” also risks unintentionally legitimising the practice and may thereby jeopardise broader efforts to abandon the practice.
For these reasons, WHO’s new guideline recommends professional codes of conduct that expressly prohibit health workers from performing FGM.
Secondly, recognising their respected role within communities, it emphasises the need to positively engage and train health workers for prevention.
Sensitive communication approaches can help health workers effectively decline requests to perform FGM, while informing people about its serious immediate and long-term risks.
Role Of The Health Sector In FGM Prevention
In a webinar last night in conjunction with the launch of the guidelines, Christina Pallitto, scientist at WHO and HRP who led the development of the new guideline, said the guideline was updated because emerging evidence had been identified that could help to update the existing recommendations from the previous guideline.
Pallitto explained that the updated guideline responds to the evolving needs of stakeholders who are implementing programmes and policies, and enables an evidence-based approach in developing those programmes and policies.
She said it also recognises the role of the health sector in FGM prevention. “So not only in management of complications, but also how the health sector can contribute to prevention efforts as well.”
The guideline is also intended to promote linkages across sectors and settings. “The guideline itself addresses both health sector response and prevention, but also how other sectors can be involved in those efforts as well.”
According to Pallitto, the revised guideline was structured around several domains.
“These include the training of health workers and how to provide access to capacity-building resources to improve their knowledge and skills, both for FGM prevention and management of complications.
“Second, the creation and enforcement of laws and policies against FGM, including codes of conduct for health workers.
“Three, the education of women and girls living with or at risk of FGM, as well as men and boys from communities that perform FGM.
Other domains include de-infibulation for women with type 3 FGM, mental health interventions for women with FGM having symptoms of depression, anxiety, or post-traumatic stress disorder, and sexual health interventions for women and girls with FGM experiencing sexual dysfunction.
Do No Harm
Two best practice statements were also developed related to laws, policies, and codes of conduct:
- Laws and policies that protect and support women and girls who have undergone or are at risk of FGM should be developed and enforced, ensuring they are applied to health workers.
- Professional codes of conduct for health workers should be developed and enforced in compliance with a zero tolerance approach to FGM aligned with human rights and ethical principles.
“We know laws and policies are foundational in enabling stakeholders to take action towards abandonment (of FGM) and that codes of conduct for health workers form the accountability mechanisms that ensure that they are promoting the rights of the populations they serve and not doing any harm,” said Pallitto.
“They also ensure that health workers adhere to the medical ethics of do no harm.”
The guideline 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.
Since 1990, the likelihood of a girl undergoing genital mutilation has decreased threefold.
However, it remains common in some 30 countries around the world, and an estimated FOUR million girls each year are still at risk.
