Tag Archives: Medicalization*

Punishment of Minor Female Genital Ritual Procedures: Is the Perfect the Enemy of the Good?

Dev World Bioeth. 2017;17(2):134–140.

Punishment of Minor Female Genital Ritual Procedures: Is the Perfect the Enemy of the Good?

Jacobs AJ, Arora KS


Female genital alteration (FGA) is any cutting, removal or destruction of any part of the external female genitalia. Various FGA practices are common throughout the world. While most frequent in Africa and Asia, transglobal migration has brought ritual FGA to Western nations. All forms of FGA are generally considered undesirable for medical and ethical reasons when performed on minors. One ritual FGA procedure is the vulvar nick (VN). This is a small laceration to the vulva that does not cause morphological changes. Besides being performed as a primary ritual procedure it has been proposed as a substitute for more extensive forms of FGA. Measures advocated or taken to reduce the burden of FGA can be punitive or non-punitive. Even if it is unethical to perform VN, we argue that it also is unethical to attempt to suppress it through punishment. First, punishment of VN is likely to cause more harm than good overall, even to those ostensibly being protected. Second, punishment is likely to exceed legitimate retributive ends. We do not argue in favor of performing VN. Rather, we argue that non-punitive strategies such as education and harm reduction should be employed.

This article can be accessed in this LINK

Virility, pleasure and female genital mutilation/cutting. A qualitative study of perceptions and experiences of medicalized defibulation among Somali and Sudanese migrants in Norway.

FREEReprod Health. 2017 Feb 10;14(1):25. doi: 10.1186/s12978-017-0287-4.

Virility, pleasure and female genital mutilation/cutting. A qualitative study of perceptions and experiences of medicalized defibulation among Somali and Sudanese migrants in Norway. 

Johansen RE.


BACKGROUND: The most pervasive form of female genital mutilation/cutting-infibulation-involves the almost complete closure of the vaginal orifice by cutting and closing the labia to create a skin seal. A small opening remains for the passage of urine and menstrual blood. This physical closure has to be re-opened-defibulated-later in life. When they marry, a partial opening is made to enable sexual intercourse. The husband commonly uses his penis to create this opening. In some settings, a circumciser or traditional midwife opens the infibulated scar with a knife or razor blade. Later, during childbirth, a further opening is necessary to make room for the child’s passage. In Norway, public health services provide surgical defibulation, which is less risky and painful than traditional forms of defibulation. This paper explores the perceptions and experiences of surgical defibulation among migrants in Norway and investigates whether surgical defibulation is an accepted medicalization of a traditional procedure or instead challenges the cultural underpinnings of infibulation. METHODS: Data derived from in-depth interviews with 36 women and men of Somali and Sudanese origin and with 30 service providers, as well as participant observations in various settings from 2014-15, were thematically analyzed. RESULTS: The study findings indicate that, despite negative attitudes towards infibulation, its cultural meaning in relation to virility and sexual pleasure constitutes a barrier to the acceptance of medicalized defibulation. CONCLUSIONS: As sexual concerns regarding virility and male sexual pleasure constitute a barrier to the uptake of medicalized defibulation, health care providers need to address sexual concerns when discussing treatment for complications in infibulated women. Furthermore, campaigns and counselling against this practice also need to tackle these sexual concerns.

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Understanding the motivations of health-care providers in performing female genital mutilation: an integrative review of the literature.

FREEReprod Health. 2017 Mar 23;14(1):46. doi: 10.1186/s12978-017-0306-5.

Understanding the motivations of health-care providers in performing female genital mutilation: an integrative review of the literature.

Doucet MH, Pallitto C, Groleau D.


BACKGROUND: Female genital mutilation (FGM) is a traditional harmful practice that can cause severe physical and psychological damages to girls and women. Increasingly, trained health-care providers carry out the practice at the request of families. It is important to understand the motivations of providers in order to reduce the medicalization of FGM. This integrative review identifies, appraises and summarizes qualitative and quantitative literature exploring the factors that are associated with the medicalization of FGM and/or re-infibulation. METHODS: Literature searches were conducted in PubMed, CINAHL and grey literature databases. Hand searches of identified studies were also examined. The “CASP Qualitative Research Checklist” and the “STROBE Statement” were used to assess the methodological quality of the qualitative and quantitative studies respectively. A total of 354 articles were reviewed for inclusion. RESULTS: Fourteen (14) studies, conducted in countries where FGM is largely practiced as well as in countries hosting migrants from these regions, were included. The main findings about the motivations of health-care providers to practice FGM were: (1) the belief that performing FGM would be less harmful for girls or women than the procedure being performed by a traditional practitioner (the so-called “harm reduction” perspective); (2) the belief that the practice was justified for cultural reasons; (3) the financial gains of performing the procedure; (4) responding to requests of the community or feeling pressured by the community to perform FGM. The main reasons given by health-care providers for not performing FGM were that they (1) are concerned about the risks that FGM can cause for girls’ and women’s health; (2) are preoccupied by the legal sanctions that might result from performing FGM; and (3) consider FGM to be a “bad practice”. CONCLUSION: The findings of this review can inform public health program planners, policy makers and researchers to adapt or create strategies to end medicalization of FGM in countries with high prevalence of this practice, as well as in countries hosting immigrants from these regions. Given the methodological limitations in the included studies, it is clear that more robust in-depth qualitative studies are needed, in order to better tackle the complexity of this phenomenon and contribute to eradicating FGM throughout the world.

This article is available in this LINK

Female genital mutilation in Sierra Leone: who are the decision makers?

Afr J Reprod Health. 2012 Dec;16(4):119-31.FREE

Female genital mutilation in Sierra Leone: who are the decision makers?

Bjälkander O, Leigh B, Harman G, Bergström S, Almroth L.

Division of Global Health, Department of Public Health, Karolinska Institute, Stockholm, Sweden. owolabi.bjalkander@ki.se


The objectives of this study were to identify decision makers for FGM and determine whether medicalization takes place in Sierra Leone. Structured interviews were conducted with 310 randomly selected girls between 10 and 20 years in Bombali and Port Loko Districts in Northern Sierra Leone. The average age of the girls in this sample was 14 years, 61% had undergone FGM at an average age of 7.7 years (range 1-18). Generally, decisions to perform FGM were made by women, but father was mentioned as the one who decided by 28% of the respondents. The traditional excisors (Soweis) performed 80% of all operations, health professionals 13%, and traditional birth attendants 6%. Men may play a more important role in the decision making process in relation to FGM than previously known. Authorities and health professionals’ associations need to consider how to prevent further medicalization of the practice.

This article can be accessed in this LINK.

Bewley et al.: Female Genital Mutilation

BMJ. 2010 Jun 2;340:c2728. doi: 10.1136/bmj.c2728.

Female genital mutilation.

Bewley S, Creighton S, Momoh C.

Comment in BMJ. 2010; 341: c3888. SEE


Paediatricians should resist its medicalisation Female genital mutilation is defined by the World Health Organization as any procedure that involves partial or total removal of the external genitalia or other injury to the female genital organs for non-medical reasons.1 Worldwide, 100-140 million girls and women are estimated to live with the consequences of such practices…

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A step forward for opponents of female genital mutilation in Egypt

Lancet. 1997 jan;349(9045)129 – 130

A step forward for opponents of female genital mutilation in Egypt

Abd El Hadi A


In July, 1996, a decree by the Egyptian Minister of Health, Dr Ismail Sallam, prohibited physicians from performing female genital mutilation in private or public health facilities. Despite the decree’s short-comings, opponents of such mutilation view it as an important step. The decree reverses the decision of the previous Minister of Health who, in 1994, overturned a 35-year ban and permitted female genital mutilation to be done in public hospitals.

The fight against female genital mutilation is not new in Egypt. Activists have raised the issue since the late 1970s, and the main focus has been the health hazards associated with female genital mutilation. However, in 1994, with the establishment of the Task Force Against Female Genital Mutilation, such opposition coalesced into a national movement, which has brought a new human rights perspective to the debate. One activist said “Whether or not female genital mutilation leads to infection, shock, or death, it is a violation of women’s bodily integrity and their reproductive and sexual rights. It is a human rights violation even if it is done in hospitals under anaesthesia and in aseptic conditions”…

This article can be purchased in this LINK

Tackling female genital cutting in Somalia

Lancet. 2001 oct;358(9288):1179

Tackling female genital cutting in Somalia

Ford N


Before the collapse of the Somali government in 1991, there was support for elimination of female gen- ital cutting; the practice was banned from hospitals and health research was conducted. But a decade of civil war put a stop to any attempts at coordinated national action of any kind, and today Somalia has one of the highest rates of genital cutting of any country—98% according to WHO.1

The most extreme form of cutting is practised in Somalia, and involves removal of the clitoris, the labia minora, and the labia majora, and subsequent rejoining the cut edges of the labia (infibulation). This is a pre- Islamic custom dating from the time of the Pharoahs and is also found in Christian and Jewish women in other parts of the Horn of Africa. This procedure is associated with significant morbidity: 39% of women in Somalia are reported to have immediate sub- stantial complications. Haemorrhage, infection, tetanus, and septicaemia are among the immediate health con- sequences; long-term effects include impaired urinary and menstrual func- tion, chronic genital pain, cysts, neu- romas, ulcers, incontinence, and infertility. Childbirth requires cutting and repairing the infibulation, which causes additional morbidity and increases the chances of maternal and child mortality…

This article can be accessed in this LINK

Correspondence: Female genital mutilation: why are we so radical?

Lancet. 2002 Feb;359:529-530

Correspondence: Female genital mutilation: why are we so radical?

Valderrama J


The medicalisation of female genital mutilation should not be officially incorporated into any organisation’s policy, but provision of medical supplies for surgical procedures may save lives and suffering. Nathan Ford (Oct 6, p 1179)1 reports on female genital mutilation in Somalia. The practice of female genital mutilation in Somalia and in northeastern Kenya within Somali populations is common. I think that the approach taken by Médecins Sans Frontières (MSF) in joining forces with women’s groups and in training traditional birth attendants and midwives is to be applauded…

This article can be accessed in this LINK

Nahid Toubia

Lancet. 2007 Mar;369(9564):819

Nahid Toubia

Shetty P


If Nahid Toubia were a city, she would be New York—dynamic, intellectual, and humorous. Ironically though, Toubia herself isn’t the city’s biggest fan. Over lunch in central London, she says she prefers calm environments to counteract her ferocious inner energy. It was this drive that led Toubia, the founder and director of the Research, Action and Information Network for Bodily Integrity of Women (RAINBO), to become the first female surgeon in Sudan.

When she returned to Sudan in 1985 after surgical training in the UK, state health care was so bad that people were dying of illnesses as treatable as asthma because the hospitals had no oxygen. Toubia set up her own clinic to offer emergency care, but the country’s political instability would force her to leave again within a few years—this time for good. Convinced that her life may be under threat, she returned to the UK, then did a stint at New York’s Population Council in 1990, at a time of growing global focus on women’s reproductive health and rights…

Special commentary on the issue of reinfibulation

International Journal of Gynecology & Obstetrics. 2010 May;109(2):97-99

Special commentary on the issue of reinfibulation

Cook RJ, Dickens BM

Faculty of Law, Faculty of Medicine and Joint Centre for Bioethics, University of Toronto, Toronto, Canada


Policy on reinfibulation exposes the interface between individual or micro-ethics and population-wide or macro-ethics. If, following childbirth, an infibulated woman requests reinfibulation, a gynecologist may respectfully advise her of its negative implications, but would not act in breach of ethical or usually legal requirements in undertaking the procedure. However, as a matter of health policy and professional responsibility, physicians should refuse to initiate infibulation, and advise their patients and communities that the procedure is harmful, not required by religious or other ordinance, and frequently if not always unlawful. Reinfibulation is not genital cutting (or “mutilation”) in itself, but when undertaken by a physician may appear to condone infibulation. This is contrary to medical professional ethics, which condemn medicalization of infibulation and generally of reinfibulation, even as a harm-reduction strategy to spare women the risks of injury and infection from unskilled interventions.

This article can be purchased in this LINK