The World Health Organization (WHO) has published new comprehensive guidelines addressing the growing concern of “medicalized” female genital mutilation (FGM) and emphasizing the critical role healthcare workers must play in ending the practice.
The guidelines, titled “The prevention of female genital mutilation and clinical management of complications,” come amid alarming evidence that healthcare professionals are increasingly performing FGM procedures, with approximately 52 million girls and women – representing about 25% of cases – having undergone FGM at the hands of medical practitioners as of 2020.
“Female genital mutilation is a severe violation of girls’ rights and critically endangers their health,” said Dr Pascale Allotey, WHO’s Director for Sexual and Reproductive Health and Research, and the United Nations’ Special Programme for Human Reproduction (HRP). “The health sector has an essential role in preventing FGM – health workers must be agents for change rather than perpetrators of this harmful practice, and must also provide high quality medical care for those suffering its effects.”
Understanding the global burden of FGM
FGM comprises all procedures involving partial or total removal of external female genitalia or other injury to female genital organs for non-medical reasons. Typically performed on girls between infancy and age 15, the practice has no health benefits and causes significant harm.
Current data reveals that over 230 million girls and women alive today have undergone FGM across 30 countries in Africa, the Middle East and Asia, with an estimated 4 million girls at risk annually. The economic burden is substantial, with treatment of FGM complications costing health systems approximately US$ 1.4 billion per year – a figure expected to rise without urgent intervention.
Dangers of medicalization
The new WHO guidelines specifically highlight the dangers of “medicalization”
– the performance of FGM by healthcare professionals. Evidence indicates that contrary to common belief, medicalized FGM may actually pose greater risks, potentially resulting in deeper, more severe cuts.
Additionally, the involvement of healthcare workers risks legitimizing the practice, potentially undermining broader abandonment efforts. The guidelines therefore recommend establishing professional codes of conduct that explicitly prohibit health workers from performing FGM under any circumstances.
Comprehensive prevention approach
The WHO guidance emphasizes a multifaceted approach to prevention:
Professional engagement
Recognizing healthcare workers’ respected community positions, the guidelines stress the importance of positively engaging and training medical professionals as prevention advocates. Research demonstrates that health workers can serve as influential opinion leaders in changing attitudes toward FGM.
“Research shows that health workers can be influential opinion leaders in changing attitudes on FGM, and play a crucial role in its prevention,” said Christina Pallitto, Scientist at WHO and HRP who led the development of the new guideline. “Engaging doctors, nurses and midwives should be a key element in FGM prevention and response, as countries seek to end the practice and protect the health of women and girls.”
Communication strategies
The guidelines recommend sensitive communication approaches to help health workers effectively decline FGM requests while educating about its serious immediate and long-term health risks, which include severe pain, excessive bleeding, infections, urinary problems, and sexual difficulties, among others.
Community involvement
Beyond the healthcare sector, the guidelines emphasize community education activities that involve men and boys, which can effectively increase knowledge about FGM, promote girls’ rights, and support attitudinal change. These community-level interventions are presented as crucial complements to legal and policy frameworks.
Improving survivor care
The guidelines also include clinical recommendations to ensure high-quality medical care for FGM survivors. Given the extensive short and long-term health complications associated with FGM, survivors often require various health services throughout their lives, including mental health support, management of obstetric risks, and where appropriate, surgical repairs.
Progress is possible
Evidence demonstrates that with appropriate commitment and support, ending FGM is achievable. Countries like Burkina Faso, Sierra Leone and Ethiopia have seen significant reductions in prevalence among 15-19-year-olds over the past 30 years by as much as 50%, 35% and 30% respectively, through collective action and political commitment to enforce bans and accelerate prevention.
Since 1990, the likelihood of a girl undergoing genital mutilation has decreased threefold. However, with FGM remaining common in approximately 30 countries worldwide, sustained effort and healthcare sector engagement remain essential to ending the practice.
- The complete guidelines are available at:
https://www.who.int/publications/i/item/9789240107281
