1. The Medicalisation of FGM
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Introduce self and purpose of presentation

2. WHO ARE 28 TOO MANY? www.28TooMany.org | info@28TooMany.org
28 Too Many is a charity working to end female genital mutilation (FGM). Our primary focus is on research and enabling local initiatives to end FGM in the 28 African countries where it is practised and across the diaspora. We also network and advocate for the global eradication of FGM, working closely with other charities/NGOs in the violence against women sector. |

3. WHAT IS FGM?
An extreme form of gender-based violence that affects at least 200 million women and girls worldwide
Partial or total removal of the external female genitals or other injury to the genitals for non-medical reasons
Four main types of FGM are recognised by the World Health Organisation
FGM is an extreme form of violence against girls and women.
It is usually performed on girls under the age of 18 and is child abuse.
FGM is not a single procedure. It is most often performed on girls between the ages of 7 and 14 but can happen from a few days old through to adulthood.
The WHO defines FGM as the partial or total removal of the external female genitals or other injury for non-medical reasons. They classify the practice into 4 main types.

4. WHAT IS FGM?
Type I
Partial or total removal of the clitoris and/or the prepuce (clitoridectomy).
Type II
Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision). Note also that the term ‘excision’ is sometimes used as a general term covering all types of FGM.
Type III
Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).
Type IV
All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization
Type 1 FGM - Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).
Type 2 FGM - Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are the ‘lips’ that surround the vagina).
Type 3 FGM - Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and sewing over the outer, labia, with or without removal of the clitoris or inner labia.
The closing over of the vagina and the urethra leaves women with a very small opening in which to pass urine and menstrual fluid. The opening can be so small that it needs to be cut open to be able to have sexual intercourse. Cutting is also needed to give birth and can cause complications which harm both mother and baby.
Type 4 FGM - Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping, stretching and cauterising the genital area.

5. Haemorrhage/bleeding Infection Shock Death FGM increases the risk of:
FGM can cause:
Severe pain
Haemorrhage/bleeding
Infection
Shock
Death
FGM increases
the risk of:
Infertility
Miscarriage
Obstructed labour
Child and maternal mortality 
FGM can also cause:
Fistula and incontinence
Painful menstruation
Difficulty passing urine/menstrual blood
Urinary tract infections
Psychologically FGM causes:
Depression
Anxiety,
PTSD and flashbacks,
Sex and relationship problems
Longer term
FGM can lead to:
Tissue scarring
Cysts
Difficult and painful sexual intercourse
All forms of FGM are extremely painful and distressing, damages sexually sensitive skin and is an infection risk.
These are some of the risks and complications that can be caused by FGM, many of which are lifelong.

6. WHAT IS THE MEDICALISATION OF FGM?
The medicalisation of FGM is when it is performed by healthcare providers or medically trained traditional cutters, either within or outside a health facility.
It is seen by anti-FGM campaigners as one of the challenges of the current worldwide campaign against FGM.

7. THE MEDICALISATION OF FGM
Providing access to medical equipment or training
Replacing severe forms of FGM with more symbolic types of cutting
Healthcare providers performing FGM on girls or women
Transporting girls to health facilities overseas
This slide details the different ways that FGM can be medicalised.
Girls or women having FGM performed in a healthcare facility
Procedures to re-establish FGM after women have
given birth (known as reinfibulation)

8. WHY MEDICALISATION?
Education about FGM highlights the harm FGM causes women and girls.
Rather than stopping the practice, some people have instead sought to change it to make it less painful and dangerous.
All FGM causes negative outcomes and medicalisation is never an appropriate solution.
Some people medicalise FGM in an attempt to reduce the health risks associated with FGM but it is not possible to reduce all the risks and complications caused by FGM.
The long-term physical and psychological harm and trauma caused by FGM cannot be mitigated by simply carrying it out in a clinical setting or sterilising the equipment.
Like many traditional cutters, doctors and nurses who carry out FGM may receive payment and this can be an incentive for them to medicalise the practice. 8

9. MEDICALISED FGM IS HARMFUL
A form of child abuse
It is a threat to the health and wellbeing of women and girls
It is medical malpractice
All FGM is harmful and a violation of the rights of girls and women.
It is sexual abuse and it is child abuse.
Medicalised FGM is a breach of medical ethics and is medical malpractice. Health professionals have a duty of care for their patients and should not cut and damage healthy parts of the body.
It is a human rights violation
It is absent of informed consent

10. “FGM changes lives. It changed mine when I was six years old and causes lifelong pain and difficulty whether or not it is medicalised. We must end all FGM.”
Hibo Wardere
Author and FGM Survivor
Hibo Wardere is a Somali born health educator who now lives in the UK.
She has recently written a book called “Cut” which details how FGM changed her life and why she campaigns to end the practice.

11. TACKLING MEDICALISATION
Professional health bodies and organisations should develop robust guidance and training for healthcare providers about medicalised FGM, ensuring all practitioners understand that medicalised FGM is medical malpractice.
Governments must ensure legislation, policies and national anti-FGM campaigns confirm zero tolerance to all FGM including medicalisation. Medical professionals who perform FGM should be held accountable.
NGOs must give clear messages that all FGM is wrong, that medicalisation is not a solution and support local efforts to end the practice.
Media reporting on FGM should support messages against medicalised FGM.
28 Too Many’s report outlines how professional health organisations, governments, NGOs and campaigners can all take action to make sure that FGM ends and is not medicalised.
The vast majority of healthcare providers oppose FGM and play an important role in preventing the practice and caring and supporting those affected by it.
We need to make sure all health professionals receiving training about FGM and are supported to stand against it.
We must also make sure that health professionals, governments and campaigners work together and that there are clear messages that all FGM must be stopped.

12. International NGO “The Girl Generation” include messages addressing the medicalisation of FGM in their anti-FGM campaign.
Organisations like the Inter-African Committee on Traditional Harmful Practices and The Girl Generation include messages about medicalised FGM in their campaigns.
They support work to raise awareness of this issue and to encourage health professional to be vigilant against the practice.

13. WHAT CAN YOU DO?
Read the 28 Too Many report “The Medicalisation of FGM”
Talk to people about FGM, including medicalisation
If you are a doctor, nurse or midwife do not support medicalised FGM, protect girls at risk and provide support and care to survivors
If you are a healthcare provider, ensure preventing and responding to medicalised FGM is embedded throughout your organisation’s policies and training

14. THANK YOU! 14