Good evening all and welcome to today’s Twitter conference. I am @aderonkeolutayo your host for today and I have with me @rayokpani co-hosting with me.

Our topic for today is “Empowering Health Workers as Advocates to end Medicalization of FGM”.  @endcuttinggirls

It promises to be educative as we Explain how health workers can be empowered to become role models and sensitise their colleagues to put an end to the medicalization of FGM.

We will provide answer to your questions from 6:40pm. Let’s go straight to the topic of today.

According to @WHO, the term “Female Genital Mutilation” refers to all procedures involving partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.

There Are 4 Types of Female Genital Mutilation

Type I: partial or total removal of the clitoris and/or the prepuce (clitoridectomy).  Subgroups of Type I FGM are:

type Ia, removal of the clitoral hood or prepuce only;

type Ib, removal of the clitoris with the prepuce.

Type II: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision). Subgroups of Type II FGM are: type IIa, removal of the labia minora only;

type IIb, partial or total removal of the clitoris and labia minora;

type IIc, partial or total removal of the clitoris, labia minora and labia majora.

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). Subgroups of Type III FGM are:

type IIIa, removal and apposition of the labia minora;

type IIIb, removal and apposition of the labia majora.

Reinfibulation is covered under this definition. This is a procedure to recreate an infibulation, for example after childbirth when defibulation is necessary.

Type IV: unclassified – all other harmful procedures to the female genitalia for nonmedical purposes, for example, pricking, piercing, incising, scraping and cauterization.

FGM of any type is a violation of the human rights of girls and women. FGM is known to be harmful to girls and women in many ways.

The removal of or damage to healthy, normal genital tissue interferes with the natural functioning of the body and causes several immediate and long-term physical, psychological and sexual consequences.

One of the main challenges of the current worldwide campaign against FGM is the trend of medicalisation.

According to WHO; “Medicalization” of FGM refers to situations in which FGM is practised by any category of health-care provider, whether in a public or a private clinic, at home or elsewhere. It also includes the procedure of reinfibulation at any point in time in a woman’s life.

Health professionals who perform female genital mutilation (FGM) are violating girls’ and women’s right to life, right to physical integrity, and right to health. They are also violating the fundamental ethical principle: “do no harm”.

The categories of health-care providers that have been found to carry out FGM include physicians, assistant physicians, clinical officers, nurses, midwives, trained traditional birth attendants (TBAs) and other personnel providing health care to the population, in both private and public sectors.

Some of the health-care providers are officially retired, but continue to provide FGM as well as other health services. With increasing awareness of the adverse health consequences and greater access to health care services, health workers have become involved in performing FGM.

Data indicates that the prevalence of FGM medicalisation is increasing, especially among mothers with secondary education.

Drawing on self-reported data on medicalization from women aged 15-49 in 25 countries, The Population Council found out that 74% of women who have undergone FGM/C report having been cut by a traditional practitioner. 26% of women with FGM/C – totalling nearly 15 million women – report having been cut by a medical professional.

Engaging Health Professionals to Support Abandonment of Female Genital Mutilation And Never To Perform It Is Critical To Success In Eliminating The Practice

Stopping medicalization of FGM is an essential component of the holistic, human rights-based approach for the elimination of FGM, as outlined by 10 UN agencies in Eliminating female genital mutilation: an interagency statement and by the Donors’ Working Group on Female Genital Mutilation/Cutting in the Platform for action: towards the abandonment of female genital mutilation/cutting.

By taking a stand in favour of abandonment of the practice and by refraining from performing it, healthcare providers will contribute to increased debate and questioning of the practice by communities.

Below are some Reasons for medicalization of female genital mutilation

While in most cases FGM is performed by traditional practitioners, parents who subject their daughter to FGM often prefer health-care providers to carry out the procedure if they think it might reduce the risks associated with the procedure.

People believe that FGM performed by Healthcare providers will reduce the health risks and/or stop its immediate complications.

People believe that health professionals are more skilled to perform FGM, yet no formal training on how to do it.

The increased demand for health-care providers to perform FGM may therefore be a result of increased information about the harmful health consequences of the practice.

A similar trend can be seen with regard to reinfibulation. Women themselves, or members of their family, may request health-care providers to perform the procedure, believing it to be less risky than if they resort to traditional practitioners.

Why Some Health-Care Providers agree to Perform Female Genital Mutilation

Most health-care providers who perform FGM are themselves a part of the FGMpractising community in which they serve. Hence, the reasons why they agree to perform FGM are often the same as those that motivate those requesting it.

In addition, studies have documented that in certain countries some health-care providers consider FGM to be medically indicated for most women, while others see the practice as harmless.

Some health-care providers, who do not themselves support FGM, still consider it their duty to support the patient’s socioculturally motivated request for FGM.

Others see medicalization as a form of harm reduction, considering that, by performing it, they help to prevent the expected greater dangers if the procedure were to be carried out by traditional practitioners.

Finally, some health-care providers are also motivated by the opportunity for financial gain. While medicalization is concentrated in Africa, health professionals worldwide have faced massive requests to perform FGM.

Why medicalization of female genital mutilation must be stopped

The performance of FGM by health-care providers, despite the global recognition of FGM as a harmful practice and a violation of human rights, constitutes a break in medical professionalism and ethical responsibility.

In most countries, it also constitutes a violation of the law. The involvement of health-care providers in the performance of FGM is likely to create a sense of legitimacy for the practice.

It gives the impression that the procedure is good for health, or at least that it is harmless. This can further contribute to institutionalization of the practice, rendering it a routine procedure and even leading to its spread into cultural groups that currently do not practise it.

Furthermore, the medicalization of FGM may lead to some health-care providers developing a professional and financial interest in upholding the practice.

Performance of FGM by health-care providers contributes to upholding the practice of FGM.

Medicalized FGM is not necessarily safer or less extensive. It also ignores the long-term complications of the practice, including sexual, psychological and obstetrical complications that have been found to be associated with FGM, independently of who performs it.

Whether medicalization is hindering the decline of FGM/C is unclear. Factors motivating medicalization include, but are not limited to, safety concerns.

Involvement of health professionals in advocacy to end FGM/C can address both the supply and demand side of medicalization, but raises ethical concerns regarding dual loyalty.

Over the last four decades, interventions aimed at ending FGM/C have combined concerted efforts of international organizations, national bodies and governments, as well as religious and civil organizations.

Health risk models formed the core of these intervention strategies.

Strategies may include the following

Raising awareness about the dangers of FGM/C, experts believed, would spur people to reassess the practice and lead to its abandonment.

Early information and education campaigns commonly featured didactic messaging about the short-term, long-term, and obstetrical consequences of FGM/C.

Each of these approaches has, to some extent, sought to raise awareness of the health consequences of FGM/C in hope of encouraging abandonment.

Health workers are increasingly being requested to perform infibulations and reinfibulations; many nurses are responding to these requests, with the justification that they can do it more safely than traditional practitioners,  and because they can supplement their income, despite the fact that the practice is illegal and punishable.

There are gaps preventing the engagement of health workers.

Low knowledge on FGM among the trainers

Lack of punitive measures for the practitioners before the new law

Lack of watchdog against the medical practitioners to curb the practice

Lack of political support.

In summary, I want to say that the practice of FGM/C greatly increases maternal and infant health complications, as well as adversely affecting women’s physical and mental health generally.

Hence, concerted efforts is needed to encourage abandonment of this harmful practice.

I will like to stop here for today so that we can take some questions from the online audience.