Female genital mutilation or cutting, also known as FGM, is largely hidden in Australia and other high-income countries. Most people don’t consider it a major issue. But our research shows it should be.
Our research found girls are presenting to paediatricians in Australia with FGM, but misconceptions about the practice are common and doctors want more information on how to manage this illegal practice.
Health professionals, lawyers, teachers, child protection authorities and communities at risk must be better informed. They must also work together to help prevent FGM, which contravenes declarations including the UN Universal Declaration of Human Rights and the UN Convention on the Rights of the Child.
What did we find?
We found health professionals worldwide are poorly informed about FGM: why it is performed, and its relationship to culture rather than religion.
Our survey of Australian paediatricians, for instance, found 10% had ever seen a child with FGM; few knew the procedure was done outside Africa; few routinely asked about or examined girls for FGM; or understood the World Health Organization (WHO) classification types. Few had read local policy on how to manage girls presenting with FGM. Most had no relevant training and requested educational resources.
Some paediatricians had been asked to perform FGM, or for information about who would perform it.
Of the girls with FGM who Australian paediatricians had seen, all were from immigrant families, mostly from Africa, and seen in refugee clinics. Two children had FGM performed in Australia. One child born in Australia was taken to Indonesia for the procedure, a country where as many as 49% of girls under the age of 14 years have had FGM.
An ancient, global cultural practice
FGM is an ancient cultural practice, entrenched in some societies. It is often wrongly thought to be dictated by religion, yet is contained in the scriptures of none. Traditionally, FGM is practised in Africa, the Middle East and Asia.
In some countries (including Egypt, Somalia and Sierra Leone) it affects more than 90% of the female population.
UNICEF identifies FGM as a global concern, estimating that over 200 million girls and women live with FGM. At current rates, 63 million more girls will have had the procedure by 2050.
What is FGM?
The World Health Organization defines FGM as:
… all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.
Procedures range from cutting or nicking the hood of the clitoris through to total removal of the clitoris and labia and sewing up the external opening (infibulation). FGM does not include cosmetic procedures such as labiaplasty that are increasingly popular in high-income countries.
What are the consequences?
FGM is usually performed in girls under 15 years old, and is often initiated by someone they trust, including family members, and conducted under non-sterile conditions, without pain relief.
Not surprisingly, FGM is associated with physical complications, ranging from bleeding to urinary tract infection, incontinence, difficulties with menstruation, sexual problems, infertility and complications during childbirth or for the newborn.
But it is the psychological trauma – post-traumatic stress disorder, flashbacks, anxiety and depression - that haunts many of the victims way beyond childhood and impacts their adult relationships.
Some women who have had FGM describe it as child abuse, gender-based violence and gender discrimination, associated with a power play by men who want to control the lives of their wives and daughters.
We are aware that preventing this ancient cultural practice requires us to understand the complex motivation behind it. Although inherently risky, the procedure is entrenched in the social fabric of many communities.
As UNICEF explains:
Communities practice [female genital mutilation or cutting] in the belief that it will ensure a girl’s proper upbringing, future marriage or family honour. In many contexts, the social norm upholding the practice is so powerful that families have their daughters cut even when they are aware of the harm it can cause.
Nevertheless, UNICEF remains firm that no form of FGM be tolerated.
For us to end FGM, we need a multi-sectoral approach including education and empowerment of women to enable them, in partnership with men in their communities, to say “no” to FGM.
To do this, communities must be supported by health professionals and child protection authorities, underpinned by legislation banning FGM.
Unlike the United Kingdom, Australia has no national integrated FGM prevention policy linking health, education and community services. This should be a priority.
Authors: Elizabeth Elliott, Professor of Paediatrics & Child Health and Director of the Australian Paediatric Surveillance Unit, University of Sydney