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 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 1 in 4 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). "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 "medicalization" also risks unintentionally legitimizing the practice and may thereby jeopardize 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, recognizing 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.
"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. Community awareness-raising activities that involve men and boys can be effective in increasing knowledge about FGM, promoting girls' rights, and supporting attitudinal changes.
In addition to prevention, 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.
Evidence shows that, with the right commitment and support, it is possible to end FGM. Countries like Burkina Faso, Sierra Leone and Ethiopia have seen reductions in prevalence among 15 – 19-year-olds over the past 30 years by as much as 50%, 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 by threefold. However, it remains common in some 30 countries around the world, and an estimated 4 million girls each year are still at risk.
