FGM: There is no justification
We have read with great interest the debate triggered by Ronan
Conroy’s editorial on female genital mutilation (FGM)(1).
Certainly Conroy can see the difference between “cosmetic” genital surgery
which follows an informed consent and female genital mutilation which
basically is done against the will of the victim. The basic fact here is
that FGM is a crime against innocent and helpless young people who have no
rights, no bargaining power.
To pay no attention to this because of similar practice in Europe and
America in the 19th century or because more recently a few ill-advised
adults are paying for “designer laser vaginoplasty” and “laser vaginal
rejuvenation” would be selfish to say the least because FGM is no longer
being practiced in the western world (because of its associated health
complications) and "cosmetic" genital surgery follows informed consent and
ability to pay and therefore cannot be equated to FGM which more often
than not is not consented to.
Although data on FGM and its attendant complications obstetric and
otherwise may be scare, Banks and colleagues (2) have found a
significantly higher risk of adverse obstetric outcomes in women who have
undergone extensive FGM compared to those who have not.
From previous experience working in obstetrics and gynaecology in
Nigeria, we have experienced first hand the emotional and obstetric issues
associated with FGM.
Therefore the real issue for this debate should not be to turn deaf
ears to this problem, or as Conroy puts it…. to tackle “cosmetic” surgery
in rich countries first before criticising traditional practices elsewhere
a)To see the need to re-examine the current WHO definition of FGM to
allow a reliable classification which would correspond to the degree of
mutilation because as Elmusharaf and colleagues have found the WHO
classification fails to relate the defined forms of FGM to severity of the
b)As health care practitioners to advise and raise awareness against
cultural/traditional practices that are a health hazard.
There is no justification whatsoever to act otherwise.
1.Ronán M Conroy Female genital mutilation: whose problem, whose
solution? BMJ 2006; 333: 106-107
2.Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M. Female
genital mutilation and obstetric outcome: WHO collaborative prospective
study in six African countries. Lancet 2006;367: 1835-41.
3.Elmusharaf S, Elhadi N, Almroth L. Reliability of self reported
form of female genital mutilation and WHO classification: cross sectional
study. BMJ 2006; 333: 124-7.
Competing interests: No competing interests