Over the next decade around 30 million girls under age 15 are at risk of FGM/C. Given that there is no physical benefit for the girls and acknowledging that FGM/C involves physical, psychological, social and reproductive harm, we, along with major international and national governmental and non-governmental organizations find FGM/C a severe violation of human rights. We must encourage vigorous action among health providers, civil society, womens organizations, funders, international agencies, international and national courts of justice, global and religious leaders, and governments to change this unacceptable practice.Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Miller, Suellen. University of California; Estados UnidosFil: Salaria, Natasha. Biomed Central; Reino Unid

Belizan, Jose

Miller, Suellen

Salaria, Natasha

Reproductive Health

English

PubMed

CONICET Digital

EDITORIAL Open AccessWe need to stop female genital mutilation!José M. Belizán1*, Suellen Miller2 and Natasha Salaria3Over the next decade around 30 million girls under age15 are at risk of FGM/C. Given that there is no physicalbenefit for the girls and acknowledging that FGM/C in-volves physical, psychological, social and reproductiveharm, we, along with major international and nationalgovernmental and non-governmental organizations findFGM/C a severe violation of human rights [1].We must encourage vigorous action among healthproviders, civil society, women’s organizations, funders,international agencies, international and national courtsof justice, global and religious leaders, and governmentsto change this unacceptable practice.It is painful to see that parents and families are impos-ing this practice on young girls including newborns.They are imposing their wills on the bodies of younggirls, who have no chance to participate in a decisionthat affects their health, safety, and lives, thus violatingtheir human rights.While in some countries legislation has beenattempted to stop FGM/C, wealthy families often avoidlegislation by taking girls to another country or by utiliz-ing licensed medical personnel. If a procedure violates agirl’s human rights, is it better in the hands of a medicalprovider? While not denying that having medicalpersonnel perform FGM/C is “harm reduction, ” and in-creases the safety of the physical procedure, for example,decreasing the risk of infection, the procedure is still ahuman rights violation. Should medical professionals beinvolved in performing FGM/C in any instance? Shouldnational and international professional organizations,universities, and governments protect girls and womenby having guidelines that strongly recommend againstFGM/C? Would religious leaders be willing to makeclear statements condemning this practice?While FGM/C is defined as cutting the genitals for“non-medical purposes” a common obstetric practice,episiotomy, when performed without clinical indications,can be categorized as FGM/C [2]. Despite evidencedisseminated more than 20 years ago that routineepisiotomy was unnecessary, and should be abandoned;the practice has continuing high incidence, with greaterthan 90 % of nulliparous women receiving episiotomy infacility births in many middle and low income countries[3–5]. Of great concern is the fact that low-incomecountries, which are making great efforts to increaseinstitutional deliveries, are performing higher rates ofunnecessary episiotomies. Increasing rates of facilitybirths are concurrent with increasing rates of unneces-sary episiotomies, despite clinical practice guidelinesthat recommend against the practice.How we can explain that there is so little researchlooking at interventions that can decrease FGM/C andepisiotomy? National and international funds, researchinstitutions and, multi-disciplinary teams should be ded-icated to develop and test interventions that successfullylead to communities abandoning FGM/C and to practi-tioners abandoning unnecessary episiotomies. Differentresearch methodologies should be used, as random as-signment to control groups or “usual and customarypractice” could be an ethical concern. However, studydesigns such as before and after, cluster randomization,time-series, step-wedge, and similar are warranted. Itwould be most desirable to have transdisciplinary teams,including social scientists, epidemiologists, health pro-viders, women’s organizations, communities’ representa-tives and politicians to develop, implement, and evaluatethe interventions.Reproductive Health is eager to contribute to decreas-ing FGM/C and episiotomies by publishing a variety ofresearch and information related to FGM/C. Submis-sions can be in a variety of formats, such as personal tes-timonies - i.e. a woman describing her own experience,case studies, descriptions of programs, and reports of in-terventions that have been tested and shown to decreaseFGM/C or episiotomies. We will encourage publicationabout these programs at local, regional or hospital leveland also changes over time of prevalence/ incidence. Wewill also publish protocols or information on initiativesthat aim to develop and test interventions that could de-crease FGM/C and episiotomy. Qualitative studies from* Correspondence: belizanj@gmail.com1Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires,ArgentinaFull list of author information is available at the end of the article© 2016 Belizán et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Belizán et al. Reproductive Health  (2016) 13:43 DOI 10.1186/s12978-016-0131-2affected women, providers, traditional health workers,political and religious leaders will be especially welcome.These contributions will be published in the form of anFGM/C-related themed series, brought together in a col-lection for easy and open access to the research andhighlighted on the journal homepage.We at Reproductive Health are committed to helpingcommunities, researchers, practitioners in the fight toabandon FGM/C, and, especially committed to helpingwomen and girls have the opportunity to live an intactlife, free of mutilation and the negative consequences ofFGM/C.Competing interestsAll authors work on Reproductive Health.Authors’ contributionsAll authors read and approved the final manuscript.Authors’ informationJosé M Belizán is Co-Editor-in-Chief of Reproductive Health, Suellen Miller is aSection Editor of Reproductive Health and Natasha Salaria is the SeniorJournal Development Editor of the journal.Author details1Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires,Argentina. 2University of California, Sacramento, USA. 3BioMed Central,London, UK.Received: 17 February 2016 Accepted: 23 February 2016References1. Muteshi JK, Miller S, Belizán JM. Are we making progress? The dynamics ofFGM/C. Reproductive Health.2. Wagner M. Episiotomy: a form of genital mutilation. Lancet.1999;353(9168):1977–8.3. Lede RL, Belizán JM, Carroli G. Is routine use of episiotomy justified? Am JObstet Gynecol. 1996;174(5):1399–402.4. Kropp N, Hartwell T, Althabe F. Episiotomy rates from eleven developingcountries. Int J Gynaecol Obstet. 2005;91(2):157–9.5. Althabe F, Belizán JM, Bergel E. Episiotomy rates in primiparous women inLatin America: hospital based descriptive study. BMJ. 2002;324(7343):945–6.•  We accept pre-submission inquiries •  Our selector tool helps you to find the most relevant journal•  We provide round the clock customer support •  Convenient online submission•  Thorough peer review•  Inclusion in PubMed and all major indexing services •  Maximum visibility for your researchSubmit your manuscript atwww.biomedcentral.com/submitSubmit your next manuscript to BioMed Central and we will help you at every step:Belizán et al. Reproductive Health  (2016) 13:43 Page 2 of 2

We need to stop female genital mutilation!

José M. Belizán

Suellen Miller

Natasha Salaria

Springer - Publisher Connector

LAReferencia - Red Federada de Repositorios Institucionales de Publicaciones Científicas Latinoamericanas

Crossref

Belizán, José M.

Sexual Reproductive Health and Rights Repository (Aga Khan University)

Belizán, JM

Salaria, N

eScholarship - University of California

EDITORIAL Open Access
We need to stop female genital mutilation!
José M. Belizán1*, Suellen Miller2 and Natasha Salaria3
Over the next decade around 30 million girls under age
15 are at risk of FGM/C. Given that there is no physical
benefit for the girls and acknowledging that FGM/C in-
volves physical, psychological, social and reproductive
harm, we, along with major international and national
governmental and non-governmental organizations find
FGM/C a severe violation of human rights [1].
We must encourage vigorous action among health
providers, civil society, women’s organizations, funders,
international agencies, international and national courts
of justice, global and religious leaders, and governments
to change this unacceptable practice.
It is painful to see that parents and families are impos-
ing this practice on young girls including newborns.
They are imposing their wills on the bodies of young
girls, who have no chance to participate in a decision
that affects their health, safety, and lives, thus violating
their human rights.
While in some countries legislation has been
attempted to stop FGM/C, wealthy families often avoid
legislation by taking girls to another country or by utiliz-
ing licensed medical personnel. If a procedure violates a
girl’s human rights, is it better in the hands of a medical
provider? While not denying that having medical
personnel perform FGM/C is “harm reduction, ” and in-
creases the safety of the physical procedure, for example,
decreasing the risk of infection, the procedure is still a
human rights violation. Should medical professionals be
involved in performing FGM/C in any instance? Should
national and international professional organizations,
universities, and governments protect girls and women
by having guidelines that strongly recommend against
FGM/C? Would religious leaders be willing to make
clear statements condemning this practice?
While FGM/C is defined as cutting the genitals for
“non-medical purposes” a common obstetric practice,
episiotomy, when performed without clinical indications,
can be categorized as FGM/C [2]. Despite evidence
disseminated more than 20 years ago that routine
episiotomy was unnecessary, and should be abandoned;
the practice has continuing high incidence, with greater
than 90 % of nulliparous women receiving episiotomy in
facility births in many middle and low income countries
[3–5]. Of great concern is the fact that low-income
countries, which are making great efforts to increase
institutional deliveries, are performing higher rates of
unnecessary episiotomies. Increasing rates of facility
births are concurrent with increasing rates of unneces-
sary episiotomies, despite clinical practice guidelines
that recommend against the practice.
How we can explain that there is so little research
looking at interventions that can decrease FGM/C and
episiotomy? National and international funds, research
institutions and, multi-disciplinary teams should be ded-
icated to develop and test interventions that successfully
lead to communities abandoning FGM/C and to practi-
tioners abandoning unnecessary episiotomies. Different
research methodologies should be used, as random as-
signment to control groups or “usual and customary
practice” could be an ethical concern. However, study
designs such as before and after, cluster randomization,
time-series, step-wedge, and similar are warranted. It
would be most desirable to have transdisciplinary teams,
including social scientists, epidemiologists, health pro-
viders, women’s organizations, communities’ representa-
tives and politicians to develop, implement, and evaluate
the interventions.
Reproductive Health is eager to contribute to decreas-
ing FGM/C and episiotomies by publishing a variety of
research and information related to FGM/C. Submis-
sions can be in a variety of formats, such as personal tes-
timonies - i.e. a woman describing her own experience,
case studies, descriptions of programs, and reports of in-
terventions that have been tested and shown to decrease
FGM/C or episiotomies. We will encourage publication
about these programs at local, regional or hospital level
and also changes over time of prevalence/ incidence. We
will also publish protocols or information on initiatives
that aim to develop and test interventions that could de-
crease FGM/C and episiotomy. Qualitative studies from
* Correspondence: belizanj@gmail.com
1Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires,
Argentina
Full list of author information is available at the end of the article
© 2016 Belizán et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Belizán et al. Reproductive Health  (2016) 13:43 
DOI 10.1186/s12978-016-0131-2
affected women, providers, traditional health workers,
political and religious leaders will be especially welcome.
These contributions will be published in the form of an
FGM/C-related themed series, brought together in a col-
lection for easy and open access to the research and
highlighted on the journal homepage.
We at Reproductive Health are committed to helping
communities, researchers, practitioners in the fight to
abandon FGM/C, and, especially committed to helping
women and girls have the opportunity to live an intact
life, free of mutilation and the negative consequences of
FGM/C.
Competing interests
All authors work on Reproductive Health.
Authors’ contributions
All authors read and approved the final manuscript.
Authors’ information
José M Belizán is Co-Editor-in-Chief of Reproductive Health, Suellen Miller is a
Section Editor of Reproductive Health and Natasha Salaria is the Senior
Journal Development Editor of the journal.
Author details
1Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires,
Argentina. 2University of California, Sacramento, USA. 3BioMed Central,
London, UK.
Received: 17 February 2016 Accepted: 23 February 2016
References
1. Muteshi JK, Miller S, Belizán JM. Are we making progress? The dynamics of
FGM/C. Reproductive Health.
2. Wagner M. Episiotomy: a form of genital mutilation. Lancet.
1999;353(9168):1977–8.
3. Lede RL, Belizán JM, Carroli G. Is routine use of episiotomy justified? Am J
Obstet Gynecol. 1996;174(5):1399–402.
4. Kropp N, Hartwell T, Althabe F. Episiotomy rates from eleven developing
countries. Int J Gynaecol Obstet. 2005;91(2):157–9.
5. Althabe F, Belizán JM, Bergel E. Episiotomy rates in primiparous women in
Latin America: hospital based descriptive study. BMJ. 2002;324(7343):945–6.
•  We accept pre-submission inquiries 
•  Our selector tool helps you to find the most relevant journal
•  We provide round the clock customer support 
•  Convenient online submission
•  Thorough peer review
•  Inclusion in PubMed and all major indexing services 
•  Maximum visibility for your research
Submit your manuscript at
www.biomedcentral.com/submit
Submit your next manuscript to BioMed Central 
and we will help you at every step:
Belizán et al. Reproductive Health  (2016) 13:43 Page 2 of 2


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