Female Genital Cutting: How Should Public Health Respond?

Last semester for my Honors Introduction to Global Health project, I put together a presentation on the very serious issue of Female Gentital Cutting (FGC), also known as female circumcision or female genital mutilation (FGM). FGC involves a number of procedures, all of which involve the removal or refiguring of outer female genitalia. All of the associated procedures also lead to a number of very serious health conditions for girls and women, including excessive bleeding, any number of infections, and often fatal complications during childbirth. Many of the reasons for the perpetuation of this practice involve the very rigid gender expectations surrounding cleanliness, beauty, and sex.

FGC is still practiced in dozens of countries, including some in Asia, the Middle East, and Africa. Despite its global prevalence and the over one hundred millions girls currently living with the effects of this practice, many people in Western nations know little about the practice, including health care professionals. This is beginning to change, however, as this article in the New York Times notes. Increased immigration to the United States as also increased the number of girls and women living in the U.S. who have undergone this practice. Many young girls are even sent to their nation of origin to have the procedure done, often without their prior knowledge or consent.

This is certainly an issue that public health must be aware of and active in addressing. Addressing gender inequities is certainly one approach to eliminating this practice. However, addressing this practice in a culturally competent way is a major challenge. For instance, what are the implications of using the word “cutting” as opposed to “mutilation?” As the article notes, many girls and women avoid seeing health care professionals or talking to their physicians about undergoing this procedure because U.S. health professionals have little to no experience with this issue. Further, these women feel that they will be judged as “backward” or “uncivilized” if others find out about having the procedure done.

This practice is illegal in the United States, and there is a push to also make sending girls abroad to have it done also a crime. However, there is concern that this will only drive the practice underground, which will only magnify the negative health effects as women will either choose or not be allowed to seek medical attention in order to protect family members. Others are arguing for a harm reduction approach that medicalizes the procedure, especially in areas where the practice is common place. Currently, the practice is not usually done by someone with any medical training, in very unsanitary conditions, with a very unclean instrument. The argument is that by medicalizing it, and allowing it to be done under the care of a health care professional, the health effects can be minimized, saving a lot of pain and many lives. But would this legitimize the practice? Or would it be another step along the way to eliminating the practice? There are no easy answers to these questions, but they are questions that need to be explored both globally and in the United States.

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