IEvery day 12,000 girls are at risk of female genital mutilation, the UN says – expose them not only to immediate pain and violations of their rights, but also to lifelong health complications and trauma. UN experts led by the Special Rapporteur on violence against women and girls, Reem Alsalem, described it this spring as “one of the most pernicious forms of violence” committed against them.
The UN set a goal of eliminating FGM by the end of this decade, and impressive progress has been made in some countries. But overall, progress has stagnated or reversed. In 2016, 200 million girls and women worldwide had undergone FGM. Since then 30 million more women have endured. Most cases of FGM – 144 million – have occurred in Africa, with a reported 80 million in Asia and 6 million in the Middle East. The decline has been slower than population growth in communities where the practice still occurs, and Unicef says girls are also being cut at younger ages, reducing opportunities for intervention.
In Sierra Leone, where FGM is still legal, three girls have died during circumcision ceremonies this year. The practice, which involves the partial or complete removal of the female genitalia, has no health benefits. All forms are associated with increased long- and short-term health risks. Alarmingly, Gambia’s parliamentarians initially backed a bid to overturn a ban on FGM this summer. Almameh Gibba, the lawmaker in charge, said he wanted to “uphold religious loyalty and protect cultural norms and values.” The country would have been the first to roll back protective legislation, setting an alarming precedent: it took determined activism from campaigners to fend off the threat. The UN estimates that as many as three-quarters of Gambian women aged 15 to 49 have undergone the practice. The rate in Sierra Leone is thought to be even higher. Legislation is needed to protect girls, although enforcement and education are also key.
There is growing concern that FGM is becoming increasingly medicalised in some places – carried out by trained staff rather than traditional practitioners, with some communities apparently seeing this as a safer way to continue the practice, despite the risks that exist even in a hospital setting. The misconception that this is necessarily less seriousand prevents complications, can make parents more willing to go ahead. It is also less visible, as families and staff often claim that a girl is undergoing another procedure. Training health professionals about the harms it causes can not only help them resist pressure to perform FGM and report it, but also change attitudes. One study found that clients of antenatal clinics with staff trained in preventing FGM themselves less supportive of practice.
Both men and women need to be addressed and involved in anti-FGM activism. Promoting gender equality more broadly is essential, as is involving traditional, political and religious leaders to raise awareness of the harms: even families who disapprove of the practice may still subject their daughters to it for fear of stigmatisation. Such work is best led by local campaigners with external support. Survivors also need support in dealing with psychological harm and accessing reconstructive surgery. Although several European countries have specialist clinics, these are not provided by the NHS. While prevention is the priority, those who have undergone FGM also need support.
