6 February : International Day of Zero Tolerance to Female Genital Mutilation
More than 125 million girls and woman alive today have been cut in the 29 countries in Africa and the Middle East where Female Genital Mutilation (FGM) is concentrated. Furthermore, due to migration, surprising numbers of cases of FGM are coming to light in other parts of the world as well. There is a need to raise awareness of the prevalence of FGM among healthcare providers in these settings to offer appropriate care for women with FGM, and to eliminate this practice.
As part of the International Day of Zero Tolerance to Female Genital Mutilation, we profile Dr. Jasmine Abdulcadir, a physician working in Geneva as part of a multidisciplinary group of healthcare providers offering services to women who have been subjected to FGM.
Interview of Dr Jasmine Abdulcadir
Dr. Abdulcadir is supporting the work of WHO/RHR in development and implementation of a research agenda that aims to address the needs of women and girls who are at risk of and who live with FGM towards improving the evidence-base for effective policies, and their implementation.
Tell us about yourself and your team’s work on female genital mutilation/cutting.
I’m the gynaecologist at a specialized clinic in the Department of Obstetrics and Gynaecology at the University Hospitals of Geneva (HUG), Switzerland, that provides services for women who have experienced female genital mutilation/cutting (FGM/C). Since April 2010, we’ve offered information and culturally-sensitive medical, surgical and psychosexual care to women with FGM/C, as well as research, teaching and prevention activities. We take a holistic and multidisciplinary approach, bringing together medical and mental health professionals who have expertise in paediatrics, midwifery, family planning, sexology, psychology/psychiatry, medical anthropology, and forensic science. Interpreters from the Red Cross accompany patients who speak languages other than French/English/Italian/Spanish so that they are able to communicate effectively, confidentially and fully understand any information we provide.
The women we see at the clinic come from several countries and have experienced different kinds of FGM/C. The majority of these women only come to our clinic for the first time after marriage or during pregnancy, for a variety of reasons. For some, it may be due to embarrassment, fear, or missed recognition by the patient or even fellow physicians. Another reason is that, in some cultures, a woman might only consult a gynaecologist once she has become sexually active (after marriage) or when she is pregnant or having trouble conceiving.
Some women come to us for information on their anatomy; others due to complications linked to FGM/C or surgery. For infibulation (narrowing of the vaginal orifice by sealing the labia minora and/or labia majora) cases, we can operate to open the scar and reconstruct the labia. This allows urine and menstrual blood to exit properly, decreases infections, and facilitates sexual intercourse and vaginal delivery. For the past year, we have also offered surgery for clitoral reconstruction, always in association with psychosexual therapy.
In your experience, what is the current level of awareness and training on FGM among health providers in Europe?
Many European countries have adopted guidelines and set up specialized clinics and women’s health support groups to increase awareness, provide information and services. The current level of awareness has certainly increased compared with some years ago. The need for trained, multidisciplinary care for women with FGM/C has been widely recognized. However, there are still serious gaps. Many European studies (including one we conducted last year) show that, in daily practice, there is insufficient basic knowledge/awareness on FGM/C diagnosis, classification, care and legislation among health providers, even gynaecologists and midwives. This may be due to a lack of training on FGM/C; discomfort with addressing the subject; fear of stigmatizing the woman; embarrassment with talking about sexuality; difficulty dealing with personal feelings concerning the practice; and a lack of time. More research is needed to understand some of the reasons and find ways of addressing them.
What measures can be taken in order to better prepare providers who may encounter women who have been subjected to FGM/C?
Health providers can take part in courses on essential cultural, medical, surgical, psychosexual, and legal information, where experts share their knowledge and experience in caring for women with FGM/C. Unfortunately, there isn’t anything on FGM/C in undergraduate or postgraduate medical teaching in many European countries. This kind of training should be included in the curriculum because misdiagnosis and missed diagnoses can have serious consequences for the care of women, communication and prevention and lead to incorrect documentation in patient files which can have legal consequences. A critical part of teaching is to convey the diversity of women with FGM/C and the types and consequences of FGM/C: some women do not have long-term complications and are healthy and do not have to be victimized or stigmatized; others suffer from severe long-term complications and can be appropriately treated.
Many European countries are developing legal frameworks to address acts of FGM/C and the women and girls who have been subjected to it. In your opinion, has this had an impact on the practice? What other preventive measures do you think are needed?
There has been an impact on general awareness in Europe. Many education programmes and guidelines that had been talked about before have actually been implemented since the introduction of laws. There have also been prosecutions and convictions for FGM/C in some countries. But laws alone are not enough to put an end to the practice. Healthcare providers, social workers, etc. all have to work together on prevention, integration and cultural change, without causing communities to lose their identity after migration. Parents need to be involved. If prevention works, health problems are avoided, with reducing the need for criminal sentences.