Are health professionals complicit in female genital mutilation (FGM)?

The practice of female genital mutilation (FGM) has been a topic of concern to contributors to this journal (Herieka & Dhar (STIs); Dominguez & Jones (STIs); Leighton & Kingston (STIs).  The problem of avoiding extremist or ethnocentric responses to this important and emotive issue is discussed in an earlier blog (Using facts to moderate the message (STI/blog)) – as well as the question of its religious basis in Islam (Sexual health this week (STIs/blog).  The introduction in the UK of mandatory reporting (September 2014) has raised the profile of this issue in this country, as well as raising the question of how professionals – in a sexual health setting as much as elsewhere – should respond (Leighton & Kingston (STIs)).

Of general relevance to this response, therefore, is a recently published review paper (Reig-Alcaraz & Solano-Ruiz) examining the role of health professionals in general, both positive and negative, in relation to FGM.  The study develops a thematic synthesis of relevant studies, descriptive, quantitative and qualitative, and seeks to cover both African countries where these practices are traditional, and American and European countries where migration has brought populations still attached to them.

Underlying the whole study is an idea which the authors argue to be well-supported by the literature: that health professionals – and midwives and nurses especially – are particularly well placed to play a decisive role in relation to FGM.  Sadly, there is little in the way of research to guide ‘holistic interventions for risk-identification, prevention and child safeguarding’.  At least, however, health professionals should be on the side of ‘no harm’.  Yet, sadly, the authors claim, some degree of complicity with FGM often seems widespread among health professionals (and not only in countries of origin) – as is proved, if nowhere else, in the support of health workers for medicalization of the practice.   Medicalization, our authors argue, may be inconsistent with the legal status of FGM (where laws against FGM exist) – and it is certainly incompatible with the ethical principles of human rights which might be supposed to be at the basis of such laws.

This ambivalence in regard to FGM seems consistent with certain weaknesses in the training and culture of health professionals which the authors find to have been identified by their sources.  These include: ignorance of protocols and guidelines where these exist (e.g. Spain); ignorance of national legislation regarding FGM (e.g. in countries of origin that outlaw FGM, as well as in countries of residence); a tendency to categorize the practice of FGM as ‘religious’ (e.g. in Spain); support for medlcalization, both in countries of origin and residence; a general lack of access to information or training on FGM.

The study seems to focus particularly on Spain.  The UK comes out little better than other countries of residence where FGM is illegal, but has not been successfully eliminated.  On a more positive note, the UK intervention described by Dominguez & Jones (STIs)) offers a example of action on the part of sexual health professionals that is ethnically sensitive without compromise on ethical principal, and seems to have had a beneficial impact.

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