KUALA LUMPUR, Dec 1 – While female genital mutilation/cutting (FGM/C) is widely recognised as a grave human rights violation with the World Health Organisation (WHO) and other UN bodies affirming that there is no medical justification for the practice, legal and policy frameworks on FGM/C remains scarce in Asia, where at least 80 million girls and women are affected by it.
“The issue still remains grossly undocumented, under-reported, unrecognised in policy spaces, public health spaces, and hence not a lot of funders, including those who fund SRHR interventions, really pay attention to this particular issue,” said Smruti Sudha Behara, senior programme officer at the Asian-Pacific Resource and Research Centre for Women (Arrow).
As FGM/C is considered more of an African practice, comprehension about it in Asia is not as high or as prevalent, said Julie Thekkudan, South Asia Consultant with Equality Now, speaking at a side event on FGM/C in Asia at the International Federation of Gynaecology and Obstetrics (FIGO) World Congress last October 8.
However, according to a recently released policy brief by the Royal College of Obstetricians and Gynaecologists, Arrow, and other NGOs, a number of countries in the region have adopted measures against FGM/C.
Indonesia First In Asia With Legal Prohibition On FGM/C
In 2024, Indonesia became the first Asian country to pass a specific legal provision against FGM/C through government regulation No.28/2024, regarding implementing the Health Law, which prohibits ‘female circumcision’ for infants, toddlers, and preschool children (likely only covering children under the age of five). There is also an implementing regulation that provides for the elimination of FGM/C.
However, the brief noted that this new regulation appears to limit the application of the legal prohibition on FGM/C to “female circumcision practices that endanger the Reproductive System”, which include practices of cutting and/or injuring or other actions that cause damage to the female genital organs.
There is a widespread understanding amongst key stakeholders in Indonesia that this new regulation means that ‘symbolic practices of FGM/C’ which do not include cutting (but rather may include touching or scraping the clitoris with an instrument) are not prohibited by the new regulation, according to the brief.
The National Commission on Violence Against Women (Komnas Perempuan) has also noted that the current prohibition on FGM/C only applies to infants, toddlers, and preschool children. Komnas Perempuan recommended that the policy to eliminate FGM/C should be expanded to apply to women of all ages.
The Impact Of Medicalising FGM/C In Indonesia
Indonesia’s move towards introducing progressive legal and policy frameworks on FGM/C, comes on the heels of regressive policies in the past that promoted the medicalisation of the practice in the country, with impacts that continue to reverberate today.
In 2010, after pressure from the Indonesian Ulema Council which had issued a fatwa promoting FGM/C, Indonesia’s Health Ministry issued a decree, prohibiting “grave types of FGM” and stipulated that only licensed doctors, midwives and nurses (preferably female) may practice FGM/C.
It also stipulated that FGM/C should only be performed upon the request or approval of those undergoing the procedure or their parent/guardian, and included a detailed standard operating procedure to be followed by skilled health personnel performing FGM/C.
The consequence of this decree was that “every hospital, even private maternity clinics, continued to perform female circumcision on the grounds that it was considered safer and more hygienic if it was performed by trained medical personnel,” according to the brief.
While this circular was withdrawn by the Indonesian Ministry of Health in 2014 following widespead outcry locally and internationally, 10 years would pass before the government announced the legal ban on health care practitioners performing FGM/C.
The promotion of medicalisation of FGM/C by the Ministry of Health’s circular contributed to FGM/C becoming a standardised procedure, which was marketed as part of a birth package in medical facilities across the country, according to the brief.
A study by Islamic Relief Canada, among others, have highlighted the widespread effects of such standardisation where it found that mothers who are delivering babies are sometimes unaware of what FGM/C entails.
They agreed to have it performed on their daughters simply because it comes as part of a complete birth package – including regular vaccinations and medical check-ups –that legitimises the practice.
“Therefore the policy that has come in place is really taking its time to counter past policies,” Thekkuda said.
Aside from being the the only country in the region that has a legal prohibition on FGM/C, Indonesia’s Midwives Association has also issued a circular calling for the prohibition of FGM/C.
National Circulars On FGM/C In South Asian And Southeast Asian Countries
While other South Asian and Southeast Asian countries have not instituted laws against the practice, in some countries, governments and national medical bodies have also issued circulars and policies prohibiting health care professionals from conducting the practice such as follows:
However, the lack of laws and policies in countries, other than Indonesia, that explicitly prohibit health care practitioners from performing FGM/C has allowed the practice to thrive in the South Asian and Southeast Asian region.
For example, although FOGSI in India has issued a circular against carrying out FGM/C, no official govenment circular has been issued on the matter.
Despite the Sri Lankan Ministry of Health’s circular instructing medical practitioners to refrain from performing FGM/C, a 2025 study found that many doctors in the country have no knowledge of the circular, and no disciplinary actions have been taken against medical professionals practising or promoting FGM/C.
In response to the Committee on the Elimination of Discrimination against Women (Cedaw), the Thai govenment has said that the practice of of FGM/C or khitan in Thailand “should be subject to the consideration of a qualified medical professional and discouraged,” according to the brief.
It also highlighted that the Brunei government supported the practice of female circumcision (excision of the prepuce) as being wajib (compulsory) under Islamic law. Reports say that FGM/C is being offerred in govenment hospitals, which indicates that the govenment supports the medicalisation of the practice.
Silence From National And Medical Professional Bodies Is Troubling
“There is no clear stance across the board in terms of FGM/C and how that has potential to cause more harm,” said Thekkudan, adding that doctors are considered to have the moral high ground and is thought to be aware of its medical implications.
The silence from national and medical professional bodies is troubling, she said. “When the doctor, the medical body, does not speak up more clearly against the practice, then in some ways you are saying that it is okay, it’s fine if you are doing it within the medical profession.”
The involvement of healthcare practitioners in FGM/C poses a serious ethical concern, noted the brief, as health care providers are not merely service providers – they are custodians of medical legitimacy.
It argued that the participation of health care professionals in FGM/C risks legitimising it as a medical procedure. This would perpetuate social norms that are anchored in medical disinformation, gender-based discrimination, and potential harm.
The brief advocated the use of the new WHO Guideline on the prevention of female genital mutilation and clinical management of complications (2025), which includes specific recommendations on capacity-building for health workers, as well as the creation and enforcement of laws and policies against FGM/C, and professional codes of conduct for health workers, to ensure accountability.
National Level Recommendations For Governments And National Bodies
It also provided the following national level recommendations for governments and national bodies on laws and policies that address FGM/C:
- Enact comprehensive laws and policies on female genital FGM/C, which also have specific provisions to prevent and prohibit the medicalisation of the practice.
- In countries where legal frameworks exist, enforce the prohibition of FGM/C by issuing clear, binding guidelines with robust monitoring and accountable mechanisms applicable to all health care settings, including private clinics, to curb the growing trend of medicalisation of FGM/C.
- Issue national circulars from the Ministry of Health, as well as professional doctors/midwives associations, prohibiting all health care practitioners from carrying out FGM/C (including practices known as ‘female circumcision’) and providing for clear mechanisms for enforcement. These circulars should apply to all health care practitioners in the country (including doctors, nurses and midwives) irrespective of whether they work in private or government hospitals and clinics.
- Include clear, comprehensive definitions of FGM/C within all laws, policies and circulars addressing the medicalisation of FGM/C and ensure that all forms of FGM/C or ‘female circumcision’, including symbolic practices, are included within its scope.
- Implement measures to ensure and meet the government’s international commitments to safeguarding the rights and wellbeing of women and girls, including but not limited to Cedaw and CRC (Convention on the Rights of the Child) recommendations.
- Set up a cross-sectoral working group bringing together health professionals, religious authorities, legal experts, and policymakers to ensure coordinated efforts to end the medicalisation of FGM/C, including advising on legal and policy responses.
