MSF Dilemma # 3: Re-Infibulation

This is the third of the dilemmas considered here.

To allow childbirth, it is necessary to surgically open an infibulation.  After delivery, women (and their husbands) ask for restoration of the infibulation (re-infibulation), which involves re-suturing. MSF opposes re-infibulation and works to ensure that it is not undertaken in its delivery facilities.  Although MSF opposes this practice, not performing re-infibulations risks jeopardising community trust, which could lead to women no longer attending the only safe childbirth service in the region.  Should the staff break MSF’s policy, honour the request of the mother, and avoid the risk of losing community acceptance?

  • Brian Hanstein

    Absent individual emergency situations, staff should be bound to follow MSF policies. If staff believe MSF policies will undermine trust within the community: A) staff should inform MSF through set procedures regarding this; and B) staff could consider and try alternate (alternative) means to secure and maintain local trust that do not violate MSF policies regarding re-infibulations. One must sympathise with the doctors out in the physically and emotionally uncomfortable field. The have much information and insight to offer the corporate leaders comfortable back in France and Belgium and the Netherlands; however, they did not volunteer as policy makers; they volunteered as healthcare providers.
    It would be a sad event if women stopped attending the 'only safe childbirth service in the region'; however, that would be THEIR autonomous decision. Healthcare should not be used as cultural blackmail or ransom. Likewise, volunteers should not allow themselves to be the victims of reverse medical blackmail. An alternative is the creation of an international medical organization that provides any and all medical care with no strings attached, with absolutely no cultural or religious biases or criticisms. That organization could not exist; adherence to the Hippocratic Oath would negate any policy to provide any and ALL medical care.