Professor Hassan Shehata is the RCOG Vice President for Global Health. In this blog, he reflects on the RCOG’s role in eradicating Female Genital Mutilation/Cutting (FGM/C), and launches a call for action by healthcare professionals and NGOs around the world to stop all forms of gender-based violence including FGM.
When we talk about FGM/C, we’re referring to procedures involving partial or total removal of external female genitalia or other injury to female genital organs for non-medical reasons. The immediate health problems following FGM/C can include haemorrhage and infection, which can result in the death of the girl or woman. Long-term complications of FGM/C include scarring, urinary problems, sexual dysfunction, and an increased risk of adverse childbirth-related outcomes, such as difficult delivery, and excessive bleeding which can also be fatal. We know that FGM/C practice harms girls and women in several other ways including immediate and prolonged psychological trauma such as depression, anxiety, low self-esteem, post-traumatic stress etc. Despite this FGM/C continues to be practised around the world. FGM/C is a human rights violation and a severe form of violence against women and girls.
More than 200 million girls and women alive today have gone through some form of FGM/C, and a further 68 million are at risk of being mutilated/cut by 2030, a stark reminder of the scale of the problem (1). These women and girls mostly live in 30 countries in Africa, the Middle East and Asia where this practice is most prevalent. It is estimated that 137,000 women and girls in the United Kingdom have undergone FGM/C (2). FGM/C has been illegal in the UK since 1985 and the government introduced a targeted safeguarding framework in 2015. Despite this and the robust campaign led by diaspora communities affected by FGM in the UK, the practice persists. In addition, UNICEF and UNFPA have estimated that another 2 million cases of FGM/C that would otherwise been averted could occur worldwide over the next decade, because of COVID-pandemic related disruption to prevention programmes (3).
FGM survivors and women rights advocates in communities affected by the practice have built an influential and strong global movement lobbying for concrete action against FGM/C for decades. During this time, international health bodies, national governments and civil society organisations have taken important measures such as the development of national action plans, inclusion of FGM/C education in training of healthcare providers and the World Health Assembly’s 2008 resolution on the elimination of this criminal practice (4).
Despite all these efforts, FGM is an enduring problem and new challenges are emerging. FGM/C is increasingly carried out by some doctors and other healthcare providers; this is known as medicalisation. 16 million women, report having been mutilated/cut by a medical professional (5). Medicalisation provides a false legitimacy to FGM/C practice: families and individuals involved in FGM/C perceive healthcare workers as doing no harm, and that their involvement shields them from the legal consequences of FGM/C, such as imprisonment. It is a fact that FGM/C is never a safe practice and will always result in harm, whoever performs it.
The RCOG's role
The RCOG has an important role to play in advocating to end FGM/C and its medicalisation, and combatting the practice using all possible platforms: by educating healthcare professionals and communities on the harmful impact of FGM/C and mobilising our global membership to end this practice. As well as amplifying the global movement of survivors and civil society groups, we aim to combat FGM through our own research, advocacy, and coordinated program of work.
As an authority on clinical standards in obstetrics and gynaecology, we have a responsibility to disseminate the truth about FGM/C. Rising trends of medicalising FGM makes our efforts an increasingly pressing priority. Our Green-top Guideline and patient information leaflet on FGM/C are two examples of action on this issue.
Our global health programmes equip healthcare professionals with knowledge, skills, and attitudes to eliminate FGM/C. We have developed a training course for health care workers, which was successfully piloted in Alexandria, in May 2023. This training is designed to help recognise the harm of FGM/C for girls and women, understand the legal consequences of practicing FGM/C, and support them to become advocates for eradicating FGM/C in their local communities. 31 healthcare workers participated in the Alexandria pilot, which was facilitated by Members of the RCOG, the Faculty of Obstetrics and Gynaecology at the University of Alexandria, and Doctors Against FGM. The College is building on this successful pilot, with plans for further training for health workers in Cairo and Sohag in Egypt in 2024. We are seeking opportunities to roll this out to other countries with high rates of medicalised FGM/C in Africa.
As Vice President for Global Health, I am committed to working with global partners to raise awareness amongst healthcare professionals. I also urge our RCOG Members and Fellows to continue working with us to end this harmful practice for women and girls around the world.
3. United Nations Population Fund (UNFPA). Impact of the COVID-19 pandemic on family planning and ending gender-based violence, female genital mutilation and child marriage. New York, NY: UNFPA; 2020 www.unfpa.org/resources/impact-covid-19-pandemic-family-planning-and-ending-gender-based-violence-female-genital.
5. Shell-Duncan B, Njue C, Moore Z. The medicalization of female genital mutilation/cutting: what do the data reveal? New York: Population Council; 2017.