NEW DELHI: Urgent measures are needed to curtail the rising “medicalization” of female genital mutilation (FGM) and to engage health workers in preventing the practice, according to new guidelines released by the World Health Organization (WHO) on Tuesday.
While the health sector plays a key role in stopping FGM and supporting survivors, evidence suggests that in several parts of the world, the practice is increasingly being performed by health workers.
As of 2020, an estimated 52 million girls and women had been subjected to FGM at the hands of health professionals—around 1 in 4 cases.
The new WHO guideline, 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. It outlines 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 be even more dangerous when performed by health workers, as it may result in deeper, more severe cuts.
Its “medicalization” also risks unintentionally legitimizing the practice and may, therefore, jeopardize broader efforts to eliminate it, the WHO said.
The WHO’s new guideline recommends that professional codes of conduct explicitly prohibit health workers from performing FGM.
Recognizing the respected role health workers play in their communities, the guideline also emphasizes the need to engage and train them in prevention efforts.
Sensitive communication approaches can help health workers effectively refuse requests to perform FGM while educating people about its serious immediate and long-term risks, WHO noted.
“Research shows that health workers can be influential opinion leaders in changing attitudes toward FGM and play a crucial role in its prevention,” said Christina Pallitto, a 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.”
In addition to effective laws and policies, the guideline underscores the importance of community education and outreach.
Community awareness-raising activities that involve men and boys can be effective in increasing knowledge about FGM, promoting girls’ rights, and supporting attitudinal change.
Alongside prevention, the guideline includes several clinical recommendations to ensure access to empathetic, high-quality medical care for FGM survivors.
Given the range of both short- and long-term health issues that result from the practice, survivors may require a variety of health services at different life stages—from mental health care to management of obstetric risks and, where appropriate, surgical repair.
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 FGM 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 threefold. However, it remains common in about 30 countries, and an estimated four million girls each year are still at risk, the WHO said.
