Rethinking the anti-FGM zero-tolerance policy: From intellectual concerns to empirical challenges

Abstract Purpose of Review Based on the discussions of a symposium co-organized by the Université Libre de Bruxelles (ULB) and the University of Lausanne (UNIL) in Brussels in 2019, this paper critically reflects upon the zero-tolerance strategy on “Female Genital Mutilation” (FGM) and its socio-political, legal and moral repercussions. We ask whether the strategy is effective given the empirical challenges highlighted during the symposium, and also whether it is credible. Recent Findings The anti-FGM zero-tolerance policy, first launched in 2003, aims to eliminate all types of “female genital mutilation” worldwide. The FGM definition of the World Health Organization condemns all forms of genital cutting (FGC) on the basis that they are harmful and degrading to women and infringe upon their rights to physical integrity. Yet, the zero-tolerance policy only applies to traditional and customary forms of genital cutting and not to cosmetic alterations of the female genitalia. Recent publications have shown that various popular forms of cosmetic genital surgery remove the same tissue as some forms of “FGM”. In response to the zero-tolerance policy, national laws banning traditional forms of FGC are enforced and increasingly scrutinize the performance of FGC as well as non-invasive rituals that are culturally meaningful to migrants. At the same time, cosmetic procedures such as labiaplasty have become more popular than ever before and are increasingly performed on adolescents. Summary This review shows that the socio-legal and ethical inconsistencies between “FGM” and cosmetic genital modification pose concrete dilemmas for professionals in the field that need to be addressed and researched

Health Care Providers’ Readiness to Adopt an Interactive 3D Web App in Consultations About Female Genital Mutilation/Cutting: Qualitative Evaluation of a Prototype

Background: Comprehensive and appropriate health care provision to women and girls with female genital mutilation or cutting (FGM/C) is lacking. Use of visuals in health care provider (HCP) consultations facilitates the communication of health information and its comprehension by patients. A web app featuring a 3D visualization of the genitourinary anatomy was developed to support HCPs in conferring clinical information about FGM/C to patients. Objective: The aim of this study was to explore HCP perspectives on the use of visuals in discussion about FGM/C with their patients as well as to obtain their feedback on whether an interactive 3D web app showing the genitourinary anatomy would be helpful in patient consultations about FGM/C, identifying key features that are relevant to their clinical practice. Methods: We evaluated the web app through a semistructured interview protocol with seven HCPs from various disciplines experienced in care for women and girls with FGM/C in migration-destination settings. Interviews were audio- and video-recorded for transcription, and were then analyzed thematically for contextualized data regarding HCPs’ willingness to use a 3D web app visualizing anatomy in FGM/C consultations with patients. Results: All but one of the seven participants expressed keen interest in using this web app and its 3D visuals of anatomy in FGM/C consultations with patients. Participants shared the common contexts for the use of visuals in health care for FGM/C and the concepts they are used to support, such as to help describe a patient’s genitals after FGM/C and reinforce an understanding of clitoral anatomy, to illustrate the process of defibulation, or to explain the physiological effects of FGM/C. Participants also highlighted the benefit of using visuals that patients can relate to, expressing approval for the ability to customize the vulva by FGM/C subtype, skin tone, and complexity of the visual shown in the web app. Despite critiques that the visualization may serve to perpetuate idealistic standards for how a vulva should look, participants largely agreed on the web app’s perceived usefulness to clinical practice and beyond. Conclusions: Evaluation of the web app developed in this study identified that digital tools with 3D models of the genitourinary anatomy that are accessible, informative, and customizable to any specific patient are likely to aid HCPs in communicating clinical information about FGM/C in consultations. Universal access to the web app may be particularly useful for HCPs with less experience in FGM/C. The app also prompts options for applications such as for personal use, in medical education, in patient medical records, or in legal settings. Further qualitative research with patients is required to confirm that adoption of the web app by HCPs in a consultation setting will indeed benefit patient care for women and girls with FGM/C. JMIR Form Res 2023;7:e44696 doi:10.2196/4469

Improving sexual and reproductive health of migrant girls and women living with female genital mutilations providing them with specific maternity care

Background: Worldwide, 200 million girls and women have been estimated as living with female genital mutilation/cutting. Today, this phenomenon does not only concern the countries where this practice is widespread, but also in many other nations where the immigrant female population comes from the countries with high prevalence, or is clandestinely practiced in the countries of destination of immigrant girls and women. It has been estimated that 50 to 80% of all African women who migrated to Italy more than 5 years ago, underwent some form of FGM. Two-third of these have been found to be afraid of seeking gynecological care. Only a small proportion of the 60% who have a vaginal delivery receive appropriate care (anesthesia and de-infibulation). FGM is responsible for specific short and long-term complications that include uro-gynaecological, obstetric, infectious, psychological and sexual consequences requiring appropriate care. The Department of Reproductive Health and Research (RHR) of the WHO has recently published new guidelines on the management of health complications from FGM with up-to-date, evidence-based recommendations. The European Union has also recently launched an E-learning tool to improve knowledge of healthcare for asylum-seekers among professionals. Its aims are to provide easily accessible information and support to professionals dealing with FGM Aim: The main scope of the project proposed is: to map existing referral centres and centres with expertise on women and girls living with FGM in Italy and make this information available for professionals and the women concerned (website, professional boards). In addition we aim to define the scientific, clinical and organisational requirements for such centres and to implement updated and evidence-based training courses in obstetric and gynaecological diagnosis and management of FGM (in particular defibulation) and its complications at a national level. Training courses will also provide useful information on further subjects, such as asylum-seekers and FGM and the legal situation concerning FGM. Finally we hope to promote research on the economical impact of FGM

Female Genital Mutilation/Cutting in the Swiss HIV Cohort Study: A Cross-Sectional Study.

FGM/C is a harmful practice that involves injury of the external female genitalia without medical purpose. It is mainly practiced in Africa, Asia, and the Middle East. However, with the migratory flows, women and girls with FGM/C and its consequences live all over the world. The lack of knowledge on how to care for women and girls living with FGM/C extends among all categories of health professionals involved in women's health, including infectious disease specialists. This is a national, exploratory descriptive cross-sectional study aimed to generate descriptive statistics about FGM/C among HIV-infected migrant women included in the Swiss HIV Cohort Study (SHCS). Among the 387 women interviewed about FGM/C and who provided an answer, 80 (20.7%) reported to have undergone FGM/C. Fifty-six of the 80 women (70.0%) who reported having undergone FGM/C, also reported that they had never discussed their cutting with a health professional before. Our study demonstrates how common female genital mutilation is in women living with HIV and who have migrated to Switzerland and suggest how care and prevention could be improved significantly

Female Genital Mutilation/Cutting in the Swiss HIV Cohort Study: A Cross-Sectional Study

FGM/C is a harmful practice that involves injury of the external female genitalia without medical purpose. It is mainly practiced in Africa, Asia, and the Middle East. However, with the migratory flows, women and girls with FGM/C and its consequences live all over the world. The lack of knowledge on how to care for women and girls living with FGM/C extends among all categories of health professionals involved in women's health, including infectious disease specialists. This is a national, exploratory descriptive cross-sectional study aimed to generate descriptive statistics about FGM/C among HIV-infected migrant women included in the Swiss HIV Cohort Study (SHCS). Among the 387 women interviewed about FGM/C and who provided an answer, 80 (20.7%) reported to have undergone FGM/C. Fifty-six of the 80 women (70.0%) who reported having undergone FGM/C, also reported that they had never discussed their cutting with a health professional before. Our study demonstrates how common female genital mutilation is in women living with HIV and who have migrated to Switzerland and suggest how care and prevention could be improved significantly

Psychosexual health after female genital mutilation/cutting and clitoral reconstruction: What does the evidence say?

Since clitoral reconstruction (CR) after female genital mutilation/cutting (FGM/C) was first reported in Egypt by Thabet and in France by Pierre Fold’s in the early 2000s, multiple scholarly publications on CR have been published by urologists, gynaecologists and plastic surgeons. Most of these publications address surgical techniques, the need for multidisciplinary care accompanying the surgery as well as issues of safety, body image, sexual and pain outcomes. CR seems to reduce/resolve clitoral pain and to improve sexual function and body image at different rates. The reduction of pain may be explained by the removal of post-traumatic painful clitoral neuromas from the FGM/C scar. The improvement of the sexual function may be due to a more accessible clitoris and/or a better body image and gender identity after surgery. However, there is still very little understanding and evidence regarding CR and less invasive treatments (e.g. psychosexual therapy). Because of this, the Guidelines on Management of FGM/C of the Royal College of Obstetricians and Gynaecologists and of the World Health Organization do not recommend CR as a standard procedure. This chapter provides an overview of what is known about sexual health and CR after FGM/C. It suggests that further collaborations and research are needed to obtain more conclusive evidence and better understanding of the medical, psychosocial and cultural dimensions of CR, and then inform and treat women and girls more effectively

Female Genital Mutilations

WHO defines Female Genital Mutilation (FGM) as all procedures that involve the partial or total removal of external genitalia or other injury to the female genital organs for non-medical reasons. The practice is still being reported in 30 countries in Africa and in some countries in Asia and the Middle East (Yemen, Iraqi, Kurdistan, Indonesia and Malaysia; there is a high prevalence of FGM in some specific geographical areas). Some forms of FGM have also been reported in specific ethnic groups in Central and South America. In the last decades, because of international migration, the number of affected or at risk of FGM girls and women has increased in high-income countries

Mutilations genitales feminines : recommandations pratiques

Les mutilations génitales féminines peuvent affecter négativement la santé psychophysique des femmes et des filles, avec diverses complications éventuelles. Il s'agit de pratiques illégales et d'une violation des droits humains. Les professionnel·le·s de la santé, et en particulier les sages-femmes, jouent un rôle fondamental dans la prévention de la pratique chez les générations futures, l'éducation à la santé, l'information et les soins appropriés, avant, pendant et après la grossesse et l'accouchement