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Background: Although Female Genital Mutilation/Cutting (FGM/C) is internationally considered a harmful practice, it is increasingly being medicalized allegedly to reduce its negative health effects, and is thus suggested as a harm reduction strategy in response to these perceived health risks. In many countries where FGM/C is traditionally practiced, the prevalence rates of medicalization are increasing, and in countries of migration, such as the United Kingdom, the United States of America or Sweden, court cases or the repeated issuing of statements in favor of presumed minimal forms of FGM/C to replace more invasive forms, has raised the debate between the medical harm reduction arguments and the human rights approach. Main body: The purpose of this paper is to discuss the arguments associated with the medicalization of FGM/C, a trend that could undermine the achievement of Sustainable Development Goal 5.3. The paper uses four country case studies, Egypt, Indonesia, Kenya and UK, to discuss the reasons for engaging in medicalized forms of FGM/C, or not, and explores the ongoing public discourse in those countries concerning harm reduction versus human rights, and the contradiction between medical ethics, national criminal justice systems and international conventions. The discussion is structured around four key hotly contested ethical dilemmas. Firstly, that the WHO definition of medicalized FGM/C is too narrow allowing medicalized FGM to be justified by many healthcare professionals as a form of harm reduction which contradicts the medical oath of do no harm. Secondly, that medicalized FGM/C is a human rights abuse with lifelong consequences, no matter who performs it. Thirdly, that health care professionals who perform medicalized FGM/C are sustaining cultural norms that they themselves support and are also gaining financially. Fourthly, the contradiction between protecting traditional cultural rights in legal constitutions versus human rights legislation, which criminalizes FGM/C. Conclusion: More research needs to be done in order to understand the complexities that are facilitating the medicalization of FGM/C as well as how policy strategies can be strengthened to have a greater de-medicalization impact. Tackling medicalization of FGM/C will accelerate the achievement of the Sustainable Development Goal of ending FGM by 2030. [ABSTRACT FROM AUTHOR]

Performing female genital mutilation (FGM) is prohibited within the UK by the FGM Act of 2003. A mandatory reporting duty for FGM requires regulated health and social care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police. An application to the court for an FGM protection order (FGMPO) can be made to keep individual women and girls safe from FGM. This paper reveals the significant disconnect between the number of FGMPO applications and known recorded cases of FGM. The introduction of FGMPOs requires critical exploration as there is insufficient evidence to show that FGMPOs are effective in protecting women and girls from FGM. It is therefore unclear what impact, if any, FGMPOs are having upon the protection of women and girls at risk of FGM. The barriers to the implementation of FGMPOs and possible solutions are discussed. [ABSTRACT FROM AUTHOR]

In this article, I discuss compulsory genital examinations in Swedish African, mainly Somali, girls. The discussion is based on data from 122 police files, including criminal investigations regarding suspected "female genital mutilation" (FGM). A growing body of research in European countries indicates that processes of cultural change are occurring among immigrant communities from areas where traditionally girls are subjected to what is construed as "circumcision". Many studies show growing opposition to these practices among people who have migrated to Europe, and there is little evidence to support the assertion that large-scale illegal activities are prevalent. Yet there is a dominant discourse stating that FGM is secretively practised on a large scale among some immigrant groups in Europe, and policies encourage the detection of cases to charge in criminal court. I describe the current situation in Sweden and highlight some of the drawbacks of a very harsh, although well-intended, policy to check for FGM in Europe. While the ultimate aim is to protect girls at risk for FGM, current policies have ramifications that are invasive and sometimes even traumatising for the girls involved. This paper offers an empirical example of how politics in western multicultural societies may negatively influence the sexual health and rights of a target group, in this case, girls and young women whose families originate from countries where circumcision of girls is practiced. [ABSTRACT FROM AUTHOR]

The history of campaigns against female genital mutilation (FGM) began in the 1920s. From the beginning, it was recognised that FGM was considered an important rite of passage between childhood and adulthood for girls, based on the importance of controlling female sexuality to maintain chastity and family honour, and to make girls marriageable. How to separate the “cut” from these deeply held norms is a question not yet adequately answered, yet I believe the answer is key to stopping the practice. Since the 1994 ICPD, national and international action against FGM has grown and resolutions have been passed in global forums which define FGM as a form of violence and a violation of children’s human rights. These resolutions have contributed to building consensus against FGM and developing national legislation criminalising FGM. Prosecutions or arrests involving FGM have been reported in several African countries and Great Britain, but apart from France, there have been very few. This paper summarises this history and how FGM has been criminalised. It argues that criminalisation may not be the best means of stopping FGM, but can have serious harmful effects itself. It calls for community-led educational information and more support for dialogue within FGM-practising communities, and argues that what is important is addressing the sexual and reproductive health consequences of FGM and gaining the understanding of women who have experienced it and their families as to why they should not make their daughters and grand-daughters go through it too. [ABSTRACT FROM AUTHOR]

Current public debate on “female genital mutilation” often renders the impression that it is possible to draw an unambiguous line between acceptable and condemnable practices of female genital cutting. In this paper, the cultural histories of cutting of the female genitalia are presented and discussed. Available historical accounts of female circumcision practices in Africa reflect Western, mainly European, ideas and ideologies at certain points in time. In a sense, these descriptions have more to say about “us” than “them”. Further, the historical descriptions of female circumcision in Africa are intertwined with time-bound notions and cutting practices in Western countries in different epochs. Through retrospective reflections, it is possible to see how current commonsensical standpoints, among them the hegemony of a “zero tolerance” attitude regarding cutting of the female genitalia among Africans, are a product of a recently introduced perspective, and also how this generally accepted perspective may render it more difficult to present multi-faceted ethnographic accounts of lived experiences today. [ABSTRACT FROM PUBLISHER]

This paper is about how female circumcision/female genital mutilation (FC/FGM) was viewed by women and men aged 18–89 in Bobo-Dioulasso, Burkina Faso, now that it has been against the law for almost 15 years. The findings come from 11 months of field research, participant observation and interviews in 2008. The practice of FC/FGM was an important issue in Bobo-Dioulasso, even though prevalence seems to be falling. The most important argument for continuing it was not a traditional role, but the need to control female sexuality – regarded as very active – not to negate it, but to ensure morally acceptable behaviour. When I talked about female genital cosmetic surgery it emerged that Bobolaise women used various substances to enhance sexual pleasure for men, both to keep the relationship and to protect the gifts and money many women needed to survive and for their children. FC/FGM was seen as a socio-cultural obligation, necessary to achieve a respectable status. Other forms of genital modification were seen as a means of satisfying male sexual needs, though vaginal tightening to hide sexual experience was also a way of demonstrating respectability. What emerged overall is that Bobolaises had their own perspectives about all the forms of female genital modification that were discussed. Cet article décrit l'idée que les femmes et les hommes âgés de 18–89 ans se font de l'excision/la mutilation sexuelle féminine à Bobo-Dioulasso, Burkina Faso, alors qu'elle est désormais illégale depuis près de 15 ans. Ces conclusions proviennent d'une recherche de terrain de 11 mois, d'observation participante et d'entretiens en 2008. La mutilation sexuelle féminine était un problème important à Bobo-Dioulasso, même si sa prévalence semble diminuer. L'argument le plus important pour la poursuivre n'était pas son rôle traditionnel, mais la nécessité de contrôler la sexualité féminine, considérée très active, non pas de la nier, mais de garantir un comportement moralement acceptable. Quand j'ai parlé de chirurgie plastique des organes génitaux féminins, il est apparu que les Bobolaises utilisaient différentes substances pour augmenter le plaisir masculin, à la fois dans le but de garder leur partenaire et conserver les cadeaux et l'argent dont beaucoup de femmes ont besoin pour survivre et pour leurs enfants. La mutilation sexuelle féminine était considérée comme une obligation socioculturelle, nécessaire pour jouir d'un statut respectable. D'autres formes de modification génitale étaient jugées comme un moyen de satisfaire les besoins sexuels masculins, même si le rétrécissement vaginal pour cacher l'expérience sexuelle était aussi une manière pour la femme de démontrer sa respectabilité. Il est apparu dans l'ensemble que les Bobolaises avaient leurs propres opinions sur toutes les formes de modification génitale féminine évoquées. En este artículo se examina la manera en que la circuncisión femenina/mutilación genital femenina (CF/MGF) era vista por mujeres y hombres de 18 a 89 años de edad, en Bobo-Dioulasso, Burkina Faso, ahora que ha sido ilegal por casi 15 años. Los hallazgos provienen de 11 meses de investigación en el campo, observación participante y entrevistas realizadas en 2008. La práctica de CF/MGF era un asunto importante en Bobo-Dioulasso, aunque la prevalencia parece haber disminuido. El argumento más importante para continuarla no era su función tradicional, sino la necesidad de controlar la sexualidad femenina – considerada como muy activa – no negarla, pero sí asegurar comportamiento moralmente aceptable. Cuando hablé sobre cirugía cosmética de los genitales femeninos, resultó que las mujeres de Bobolaise utilizaban diversas sustancias para realizar el placer sexual de los hombres, tanto para mantener la relación como para proteger los regalos y el dinero que muchas mujeres necesitaban para sobrevivir y para sus hijos. La CF/MGF era vista como una obligación sociocultural, necesaria para lograr una condición social respetable. Otras formas de modificación genital eran consideradas un medio de satisfacer las necesidades sexuales del hombre, aunque apretar la vagina para ocultar la experiencia sexual también era una manera de demostrar respetabilidad. En general, se determinó que las personas de Bobolaise tenían sus propias perspectivas sobre todas las formas de modificación genital femenina discutidas. [ABSTRACT FROM AUTHOR]

Female Genital Cutting (FGC) is increasingly being performed by trained health professionals. International, national, and local institutions strongly oppose this medicalization trend, arguing that the involvement of health-care providers in the performance of FGC will counteract efforts to eliminate the practice. However, no empirical research to date has confirmed or refuted this claim. Therefore, it remains unclear how the medicalization of FGC relates to changes in the prevalence of the practice. In the current paper, we aim to fill this gap in the literature by examining the association between this medicalization trend and the risk of FGC. We focus on Egypt because of its high medicalization and prevalence rates and its unique history of FGC legislation. We performed a discrete-time event-history regression analysis combined with governorate fixed effects using the Egyptian Demographic Health Surveys from 2005, 2008, and 2014 (N = 49,273 daughters clustered within 29,810 mothers). Our results show that increasing medicalization rates coexist with decreasing prevalence rates. This effect is particularly pronounced in a context where a substantial number of cuts were medicalized (estimated at 40% and above). This effect is significantly more pronounced in higher educated mothers. Our study thus shows that the medicalization of FGC can coincide with decreasing prevalence rates of FGC. Medicalization of FGC may take place in a context where an awareness of the health hazards related to FGC is more pronounced, thereby also discouraging the practice as a whole. In addition, the medicalization of FGC may make the practice more individualized and therefore reduce the incentives for FGC. • The FGC medicalization trend coincides with decreases in FGC prevalence in Egypt. • A sharp decline in FGC prevalence is established in the youngest age groups. • Increases in the medicalization of FGC reduce the risk of FGC even further. [ABSTRACT FROM AUTHOR]