COMMENTARY

Female Genital Mutilation: Why Are Doctors Silent?

Ranit Mishori, MD, MHS

Disclosures

January 07, 2019

Editorial Collaboration

Medscape &

How Do We End Medicalization of FGM/C?

In the absence of federal and state laws to ban this procedure (only 27 states currently have laws against FGM/C), whose responsibility is it to tell US physicians that they cannot engage in this practice?

A United Nations interagency statement on ending medicalization recommended that ministries of health "and professional regulatory bodies and syndicates

should issue policy statement against the medicalization of FGM."[5] The document further states that "professional organizations should adopt and disseminate clear standards condemning the practice."

Indeed, health-profession organizations often serve as thought leaders through the creation of practice guidelines, policies, and position statements. Often, such documents set the tone and direction for the organization and describe desired methods, behaviors, and actions applicable to the entire organization and its members.

Have US health professional organizations taken on FGM/C? Two Georgetown University colleagues, Isha Choudhary, MD, and Soyun Kim, PhD, and I sought to answer this question.[8]

We selected specialties and organizations whose members, by nature of their training, may be tasked with caring for female patients with, or at risk for, FGM/C. These organizations represented healthcare professionals in women's health, family medicine, pediatrics, dermatology, urology, internal medicine, plastic surgery, and emergency medicine.

Initially, we found that only four (26%) of 15 US-based, physician-focused organizations had any statements about FGM/C. Kudos to the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the American Medical Association (AMA),[10] and the American College of Obstetricians and Gynecologists (ACOG). [9] That was a year ago. At the moment, a search on ACOG's site for any policy or position statements on FGM/C turns up nothing at all. And this is an organization whose main mission is women's health.

The American College of Nurse-Midwives (ACNM) also has one. Overall, this is pretty poor considering that, according to some estimates, more than 500,000 women and girls in the United States are at risk for FGM/C or its consequences.[11]

Only three out of these five organizations had explicit statements about clinician involvement in FGM/C.

In its statement, the AMA noted that it is "in opposition to the practice of FGM by any physician or licensed practitioner In the US." The AAP "counsels its members not to perform such procedures." ACNM states that midwives must "decline to perform FGM/C."

Silent on the matter were ACOG and the AAFP (who had general statements about FGM/C) and all of the other organizations serving as the collective voices of hundreds of thousands of physicians. (Full disclosure: I wrote the AAFP policy statement, so it is totally on me. Why didn't I include it? Naiveté and shortsightedness.)

In comparison, all of the seven Canadian physicians' organization we assessed had statements on medicalized FGM/C. Some organizations used stronger language than others, but overall the message was clear: This is not something doctors should do.

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