COMMENTARY

Female Genital Mutilation: Why Are Doctors Silent?

Ranit Mishori, MD, MHS

Disclosures

January 07, 2019

Editorial Collaboration

Medscape &

A federal judge in Michigan recently ruled that a federal ban on female genital mutilation/cutting (FGM/C) was unconstitutional.[1] Charges against two local doctors accused of performing the procedure on young girls were dismissed. Other charges are still pending against one of the doctors and a few of their accomplices, but this case has shone a light on a practice that's becoming all too common around the world: medicalized FGM/C.[2]

FGM/C is a procedure in which parts of the female genitalia are cut to varying degrees,[3] usually before a girl turns 15. According to UNICEF, at least 200 million women and girls worldwide are affected.[4] The practice is considered a human rights violation and may have lifelong health and psychological consequences.

The Medicalization of FGM/C

Most commonly, FGM/C is carried out by traditional practitioners. In recent years, however, we have seen a trend moving it away from villages and homes, where it has usually been done, and into hospitals, clinics, and private offices. The location change has ushered in a vocational change. Health professionals—doctors and nurses—are now frequently the ones performing this procedure on young girls.[5]

Medicalization is rapidly increasing around the world. For example, in Egypt and Sudan, where FGM/C is nearly universal, almost 80%[5] of procedures are performed by members of the health sector. Medicalization is also significant in the Middle East and parts of Asia. Reports about clinics performing it pop up every now and then in other parts of the world, most recently in Russia.[6]

Do No Harm

Why are health professionals, who have sworn to do no harm, participating in a practice that is considered a human rights violation? A recent review[7] of 14 studies conducted in countries where FGM/C is common documented several ways that health professionals rationalize their participation.

Harm reduction. Some believe in the "harm reduction" theory—essentially that doctors can do it more safely and under better hygiene conditions than having it performed by traditional cutters.

Cultural concerns. Some clinicians were convinced of the benefits of the tradition. Other were influenced by their cultural beliefs.

Financial considerations. For some, it is a financial boon, like any other surgical procedure.

Community requests. Some healthcare providers indicated that their participation was the result of pressure from their community to perform FGM.

It is not surprising, then, that individuals who believe in FGM/C would seek out doctors right here in the United States to carry out these procedures.

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