KUALA LUMPUR, Nov 24 – Despite the dearth of medical and scientific evidence to support the practice of female genital mutilation/cutting (FGM/C), it has continued to flourish in Asia, where data updated by UNICEF in March this year estimates that approximately 80 million girls and women in the region have been subjected to the practice.
According to a recently released policy brief by the Royal College of Obstetricians and Gynaecologists, the Asia Netwok to End FGM/C, the Asian-Pacific Resource and Research Centre for Women (Arrow), and other NGOs, evidence indicates that FGM/C occurs in at least 12 countries across South and Southeast Asia.
These countries include India, Pakistan, Sri Lanka, Maldives, Vietnam, Cambodia, Thailand, Brunei, Singapore, Philippines, Indonesia, Malaysia, and Azerbaijan, said Smruti Sudha Behara, senior programme officer at Arrow, who added that the actual prevalence can be much higher than the estimate.
“It is mainly because of under-reporting and the limited data across countries beyond Indonesia and Malaysia,” she said, speaking at a side event on FGM/C in Asia at the International Federation of Gynecology and Obstetrics (FIGO) World Congress last October 8.
Indonesia And Malaysia Account For More Than One-Third Of The Regional Burden
“The Orchid Project, in its study in 2025, estimated that Indonesia and Malaysia together account for more than one-third of the regional burden of 80 million cases, with about 77.5 million women and girls of all ages from these two countries affected.
“The prevalence is particularly high amongst the ethnic Malay communities, which exceeds 90 per cent in Malaysia.”
Meanwhile, in Indonesia, certain regions, such as Sulawesi, report prevalence rates as high as 81.2 per cent, Smruti said.
The types of FGM/C most commonly practiced in Asia are Type 1, which is the partial or total removal of the clitoral glans (the external and visible part of the clitoris), and Type 4, which include pricking, scraping, incising, etc, the genital area, as well as certain symbolic forms of FGM/C.
The term FGM/C as used in the brief includes the many terms used to describe this practice in different countries in South and Southeast Asia, such as female circumcision, female genital cutting, khatna, sunat, sunat perempuan, khitna, and other terms or acronyms depending on the specific local context involved.
“The short and long-term effects of FGM/C in Asia are largely undocumented and further research is required to unpack the harm that is caused, especially in the context of anecdotal information, pointing to possible post-procedural complications such as infections, long-term pain after child delivery, negative impact on women’s sex life, and emotional impacts,” Smruti said.
According to the brief, documented complications of Type 1 from other regions include severe pain, genital swelling, haemorrhage, infection, and the risk of septicaemia.
52 Million Girls, Women Today Subjected To FGM/C By Health Workers
Despite this, the trend of medicalising FGM/C — which refers to situations where FGM/C is perfomed by any category of health care provider in any setting including clinic, home, or elsewhere — is on the rise. Recent estimates indicate that approximately 52 million girls and women today were subjected to FGM/C by a health worker.
“It (the medicalisation of FGM/C) is driven by the trends of urbanisation, the decline of traditional birth attendants who usually used to do this practise earlier — they are declining within the formalised health system,” Smruti said.
According to the brief, the bidans (midwives) who traditionally performed FGM/C in Malaysia and Southern Thailand are dying out. In Thailand, the long-term policy is to eliminate the practice of bidans in Southern Thailand, as they are no longer being granted training or licenses.
However, with no corresponding decrease in demand for FGM/C from the community, this is contributing to increasing trends of medicalisation.
Smruti added that there is also an increased demand from parents who have now become more acquainted with the potential health complications of FGM/C, customarily done by traditional healers using unsterilised equipment.
Medicalisation Wrongly Legitimises The Practice As Medically Sound
It has been internationally recognised though, that medicalisation of FGM/C does not eliminate the harm it causes and that the practice has no sound scientific basis.
“Health care professionals are not taught how to perform FGM/C in medical schools and most learn how to perform it informally from senior doctors and traditional healers,” Smurti said.
Most studies on medicalisation have highlighted that often the health care practitioners who perform FGM/C belong to the same communities in which the practice is prevalent, according to the brief.
As such, they carry out the practice likely due to their beliefs in the religious and cultural justifications, awareness of social consequences towards girls and their families as a result of not being cut, and perceived minimal or reduction in harm when it is conducted in a medical setting — despite their lack of formal training on how to perform FGM/C.
The policy brief noted that the medicalisation of FGM/C may “wrongly legitimise the practice as medically sound or beneficial for girls and women’s health. It can also further institutionalise the procedure as medical personnel often hold power, authority, and respect in society.”
Smurti said medicalisation of FGM/C takes place in at least eight countries in South and Southeast Asia, including Brunei, India, Indonesia, Malaysia, Pakistan, Singapore, Sri Lanka, and Thailand.
“In Asia, the highest medicalisation rates are in Indonesia, Malaysia and Singapore. However, data from these countries again indicate that medicalisation of FGM/C is rising, not just in these three countries, but also across the region, with almost all the countries reporting that younger girls were more subjected to FGM/C by health care practitioners as compared to the older generation,” she said.
Gradual Shift Toward Medicalisation Of FGM/C in Indonesia
Over the past two decades, a gradual shift toward the medicalisation of FGM/C has been taking place in Indonesia, with nearly half of all FGM/C interventions being carried out by midwives, due to perceived safety, accessibility, and inclusion of the practice as part of standard maternity packages, according to the brief.
National prevalence data show that in urban areas, 58.2 per cent of FGM/C cases were performed by medical professionals, compared to rural areas, where they accounted for 35.2 per cent of cases.
According to a study published this year by the Asia Network, Indonesian health care workers cited parental demand and fear of social exclusion, sharing community values, as well as a belief that FGM/C can occur more safely in a hygienic medical setting as reasons for continuing to carry out the practice.
However, some studies indicate that health care practitioners may be more likely to perform more severe forms of cutting. A 2017 study found that health professionals are twice as likely to perform Type 1 FGM/C (46 per cent), in comparison to traditional birth attendants (23 per cent), who are more likely to perform Type 4 or a symbolic form of FGM/C.
Steady Transition From Midwives To Health Care Professionals In Malaysia
Malaysia has also seen a steady transition from FGM/C being carried out by midwives to being performed by health care professionals since the 1980s.
“In Malaysia, FGM/C is performed primarily by doctors and a 2020 study found that 85.4 per cent of doctors interviewed stated that female genital cutting should continue,” said Smurti.
They mainly perform nicking of the clitoris/prepuce (Type 4), although a small number of doctors practise a more invasive form by cutting the external clitoris (Type 1).
Alarmingly, a study has also found that a significant number of doctors in Malaysia who practise FGC/M have implied that they may have insufficient knowledge of clitoral anatomy and physiology.
In Singapore, a pilot study in 2020 by End FGC Singapore found that 47.3 per cent of respondents who had undergone FGMC were cut by doctors. However, a significant percentage of respondents (35 per cent) indicated that they did not know who performed the cutting, suggesting that medicalisation may be much higher than reported.
According to End FGC Singapore, most cases of FGM/C, which they are aware of, are occurring in about five general practitioner (GP) clinics, performed by Muslim female doctors across the nation.
FGM/C Being Conducted Discreetly By Private Clinic Physicians In Sri Lanka
While there is limited data from Sri Lanka, a study by Women’s Action Network this year, which involved about 998 participants, showed that while traditional practitioners, known as ostha maamis, historically performed most of FGM/C in Sri Lanka, there is a growing trend of FGM/C being conducted discreetly by physicians mostly in private clinics, according to the brief.
The study found that especially in metropolitan areas, FGM/C is advertised to the community on social media, with listings of doctors and hospitals who provide female circumcision services.
“Small scale studies and media reports have also documented medicalisation in Brunei, India, Pakistan, and Thailand with data indicating that there is again a growing trend across the region with people moving from traditional birth attendants and healers to health care professionals, thereby increasing the incidences of medicalisation of FGM/C,” said Smurti.
Thailand Doctors: Practice Should Not Be Considered Mutilation If Done By Doctor
In Thailand, a few doctors have been quoted in news reports as saying that they perform between ten and 20 procedures a month and that they believe the practice, if done by a doctor, should not be considered mutilation, according to the brief.
However, based on existing studies, there is no evidence to show that the medicalisation of FGM/C has resulted in harm reduction.
In fact, studies from Indonesia and Malaysia indicate that health care professionals are more likely to undertake more severe forms of cutting (Type 1) as compared to traditional practitioners, with the involvement of anaesthetics and anatomical knowledge possibly resulting in deeper and more extensive cuts.
As the medicalisation of FGM/C continues to rise in Asia, posing a challenge to the sexual and reproductive health and rights of girls and women in the region, there are also signs of growing awareness of it harms.
Reports indicate that in recent years, more midwives in Indonesia are refusing to perform FGM/C, opting instead to clean the baby’s genitals with betadine without informing parents.
