ABSTRACT
OBJECTIVES: To decrease the likelihood that the practice of female genital cutting (FGC) be continued in the future and to improve the care of girls and women who have been subjected to FGC or who are at risk by providing (1) information intended to strengthen knowledge and understanding of the practice, (2) information regarding the legal issues related to the practice, (3) guidance for the management of its obstetrical and gynaecological complications, and (4) guidance on the provision of culturally competent care to girls and women affected by FGC. OPTIONS: Strategies for the primary, secondary, and tertiary prevention of FGC and its complications. OUTCOMES: The short- and long-term consequences of FGC. INTENDED USERS: Health care providers delivering obstetrical and gynaecological care. TARGET POPULATION: Women from countries where FGC is commonly practised and Canadian girls and women from groups who may practise FGC for cultural or religious reasons. EVIDENCE: Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library in September 2010 using appropriate controlled vocabulary (e.g., Circumcision, Female) and key words (e.g., female genital mutilation, clitoridectomy, infibulation). Searches were updated and incorporated in the guideline revision December 2018. VALIDATION METHODS: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS: There are no anticipated harms or costs to health care facilities with implementation of this guideline. Benefits may include a greater willingness of women living with FGC to seek timely care. SUMMARY STATEMENTS: RECOMMENDATIONS.
Subject(s)
Circumcision, Female/standards , Culturally Competent Care , Practice Guidelines as Topic , Female , Gynecology , Humans , Societies, MedicalSubject(s)
Circumcision, Female/standards , Religion , Circumcision, Female/trends , Cultural Characteristics , Female , Finland , Humans , Infant, Newborn , Risk AssessmentSubject(s)
Ceremonial Behavior , Circumcision, Female/standards , Circumcision, Male/standards , Attitude of Health Personnel , Circumcision, Female/trends , Circumcision, Male/trends , Cultural Characteristics , Female , Finland , Humans , Infant, Newborn , Male , Religion , Risk Assessment , Societies, MedicalSubject(s)
Circumcision, Female/ethics , Circumcision, Female/legislation & jurisprudence , Circumcision, Female/standards , Circumcision, Male/legislation & jurisprudence , Circumcision, Male/standards , Government Regulation , Child , Circumcision, Male/ethics , Cultural Diversity , Female , Humans , Infant, Newborn , Male , Religion and Medicine , United StatesABSTRACT
Female circumcision/female genital mutilation (FC/FGM) refers to any alteration of the genitalia by excision or covering of the introitus done for nonmedical reasons. This procedure is widely prevalent in sub-Saharan Africa and is traditionally performed on children and young adolescents. FC/FGM is associated with acute and long-term genitourinary and reproductive disorders that may require medical intervention. Due to turbulent economic and political immigration patterns, Western physicians may be called upon to care for children or adolescents from this part of the world. This review explains the procedure and the resultant physical alterations as well as the cultural and historic basis of this ancient tradition. Emphasis is also placed on the elements of culturally competent and compassionate care for young women who have undergone FC/FGM.
Subject(s)
Circumcision, Female/standards , Cultural Characteristics , Adolescent , Adult , Child , Circumcision, Female/trends , Developing Countries , Female , Follow-Up Studies , Humans , Risk AssessmentABSTRACT
In recent decades the practice of female "circumcision" has come under intense international scrutiny, often conceptualized as a violation of women's basic right to health. Although the adverse health consequences of female "circumcision" form the basis of opposition to the practice, anti-circumcision activists, as well as many international medical associations, largely oppose measures to improve its safety. The debate over medicalization of female "circumcision" has, up until now, been cast as a moral dilemma: to protect women's health at the expense of legitimating a destructive practice? Or to hasten the elimination of a dangerous practice while allowing women to die from preventable conditions? This paper seeks to re-examine this debate by conceptualizing medicalization of female "circumcision" as a harm-reduction strategy. Harm reduction is a new paradigm in the field of public health that aims to minimize the health hazards associated with risky behaviors, such as intravenous drug use and high-risk sexual behavior, by encouraging safer alternatives, including, but not limited to abstinence. Harm reduction considers a wide range of alternatives, and promotes the alternative that is culturally acceptable and bears the least amount of harm. This paper evaluates the applicability of harm reduction principles to medical interventions for female "circumcision," and draws parallels to other harm reduction programs. In this light, arguments for opposing medicalization of female "circumcision", including the assertion that it counteracts efforts to eliminate the practice, are critically evaluated, revealing that there is not sufficient evidence to support staunch opposition to medicalization. Rather, it appears that medicalization, if implemented as a harm-reduction strategy, may be a sound and compassionate approach to improving women's health in settings where abandonment of the practice of "circumcision" is not immediately attainable.
