A health worker engaging a fellow to end FGM. Courtesy Photo
World Health Organization (WHO) has called for urgent measures to end the rising “medicalization” of female genital mutilation (FGM) and to engage health workers to prevent the practice.
While the health sector plays a key role in stopping FGM and supporting survivors, evidence from several parts of the world suggests the practice is increasingly being performed by health workers.
As of 2020, an estimated 52 million girls and women had undergone FGM at the hands of health workers — around 1 in 4 cases.
The new WHO recommendations, titled The prevention of female genital mutilation and clinical management of complications, provide a framework 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).
Dr. Pascale added, “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 it, FGM causes serious harm. Some studies suggest it can even be more dangerous when performed by health workers, resulting in deeper, more severe cuts. Medicalizing the practice also risks legitimizing it and undermining broader efforts to eliminate it.
For these reasons, WHO recommends that professional codes of conduct explicitly prohibit health workers from performing FGM. Recognizing their respected role within communities, the organization also emphasizes the need to positively engage and train health workers for prevention. Sensitive communication approaches can help them effectively refuse requests to perform FGM, while informing communities about its serious immediate and long-term health 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 measures. “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, WHO stresses the importance of community education and information-sharing. Awareness-raising activities that involve men and boys can be particularly effective in increasing knowledge about FGM, promoting girls’ rights, and driving changes in attitudes.
In addition to prevention, the new recommendations include clinical approaches to ensure empathetic, high-quality medical care for FGM survivors. Given the extent of both short- and long-term health complications resulting 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 such as 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, thanks to collective action and strong political will to enforce bans and accelerate prevention.
Since 1990, the likelihood of a girl undergoing genital mutilation has decreased by threefold. However, the practice remains common in some 30 countries worldwide, and an estimated 4 million girls are still at risk each year.
