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RCOG statement on F1000 Research paper about FGC (5 October 2012)

News 13 November 2012

The Royal College of Obstetricians and Gynaecologists (RCOG) is aware of the paper ‘Female genital cutting is a harmful practice. Where is the evidence?’ recently published in F1000 Research.

In the commentary, the author makes the argument that the evidence on the harmful effects of female genital cutting, when performed by doctors and nurses in medical facilities with access to pain relief, is poor. The author goes on to suggest that female circumcision should be permissible in cases where the parents insist on it.

The proposals in this paper amount to the medicalisation of FGM and is reminiscent of the American Academy of Paediatrician’s policy statement in 2010, which was later rescinded. We welcome academic debate and discussion of cultural issues that raise the awareness of healthcare professionals and policy makers. However, the RCOG rejects the recommendations made.

There can be no medical justification for type 1 FGM to be carried out. This is defined by the WHO as a clitoridectomy, or the partial or total removal of the clitoris and/or vaginal hood.

The RCOG’s position on any form of female circumcision is clear. It is mutilation. Referring to the practice as ‘female genital cutting’ instead of FGM will not make it more acceptable. It is an obsolete practice that has no known medical benefit and only serves to further subjugate women. The evidence on the long-term physical and psychological morbidities that arise from FGM led to the publication of an RCOG clinical guideline in 2009.

There is no place for FGM in any society, and particularly in a modern, progressive society.

According to the United Nations, FGM is a violation of the human rights of girls. The RCOG believes that there are cultural reasons why FGM is sometimes undertaken with parental consent. It is therefore vitally important in the UK to ensure that parents and guardians from communities where FGM is still practised are informed about the lifelong problems that can arise from FGM so that this practice can be eradicated.

The strategy of harm reduction by sanctioning healthcare professionals to carry out FGM condones and prolongs the practice. It legitimises FGM and introduces financial reward.

Professor James Walker, RCOG Vice President (Global Health) said, “Earlier this year, there were media reports about the procurement of FGM in England. We need to target certain communities and educate parents and young girls about the harmful effects of FGM in the continued effort to stamp it out.

“Apart from a human rights issue it is also a child protection issue and better support needs to be provided to young girls so they feel confident enough to report cases. Healthcare professionals must also receive training on the appropriate care and treatment for women who present with FGM.”

Tackling FGM in the UK requires a multi-agency approach and the relevant government departments must work closely with organisations such as Equality Now and Forward to eradicate the practice in the UK.

Notes

Since the publication of this commentary, and following peer review, the author has changed the title of the paper to ‘Female circumcision: limiting the harm’.

The author has stated that he does not condone the practice of FGM and supports the total elimination of the practice but a ban in some countries presently may mean some women will resort to illegal and unsafe means to be circumcised.