The medicalisation of Female Genital Mutilation/Cutting (FGM/C), where the procedure is performed by healthcare professionals, has complicated global efforts to eradicate this harmful practice. Rather than ending FGM/C, medicalisation risks legitimising it under the guise of clinical safety. These concerns were first raised during the April 2025 webinar hosted by the Asia Network to End FGM/C and Equality Now, which brought together experts from Asia and Africa to discuss the roles healthcare professionals play in perpetuating or preventing FGM/C.

This follow-up discussion explores how legal frameworks, medical ethics, and debates around female genital cosmetic surgery (FGCS) intersect with ongoing efforts to address FGM/C.

Medical Ethics and Legal Contradictions

In the UK, the Female Genital Mutilation Act 2003 criminalises excision, infibulation or other mutilation of a girl’s or woman’s genitals, including adult procedures. It permits exceptions only when medically necessary, such as during childbirth. Despite this, FGCS is legally offered to adult women and often promoted as enhancing sexual, gynaecological or mental health.

This duality exposes contradictions in how the law distinguishes between cultural harm and personal choice. Medical ethics face similar tensions. Healthcare professionals are tasked with protecting health, yet may accept patient consent at face value without examining the patriarchal narratives that shape such decisions.

Is Female Genital Cosmetic Surgery a Form of FGM/C?

Saarrah Ray, a DPhil in Law candidate at the University of Oxford, challenges the separation between FGCS and FGM/C. In her thesis, she frames FGCS as a form of violence against women and argues for its recognition as a variant of FGM/C. In Sister, Is this Mutilation? she writes:

“It is worth appreciating that FGCS and FGM seem not so disanalogous if we take seriously the depth and harm of socio-cultural pressures, deriving from a shared system of women’s oppression, that inform women how to feel what their vulvas and vaginas should look like and whom they service.” (Ray, 2024)

Ray questions whether women’s consent to FGCS, often influenced by beauty myths, pornography and self-objectification, can be ethically relied upon by medical professionals. For instance, if a woman undergoes vaginal tightening to satisfy a partner, her satisfaction may not reflect autonomous decision-making but internalised gender norms.

This argument raises critical questions for both law and medicine. Should healthcare systems permit procedures rooted in oppressive social expectations? And should the law continue to draw rigid lines between culturally sanctioned FGM/C and socially accepted FGCS, when both may stem from the same systems of control?

The medicalisation of FGM/C, and the rise of FGCS, expose gaps in both legal and ethical frameworks. As highlighted in the April 2025 webinar, addressing these issues requires more than legal bans, it demands a deeper interrogation of consent, culture and power. When procedures rooted in patriarchal norms are reframed as healthcare, both medicine and law must respond with clarity, accountability and a commitment to women’s rights.

Speaker Profiles

Professor Samuel Kimani
Associate Professor, Faculty of Health Sciences, University of Nairobi. With over 20 years of experience in global health, medical training, and research, Professor Kimani is a leading expert on FGM/C in Africa.

Dr Hannah Nazri
NIHR Academic Clinical Fellow in Obstetrics & Gynaecology, University of Warwick. Director of Malaysian Doctors for Women & Children. Dr Nazri works internationally to end FGM/C through education, policy engagement, and healthcare leadership.

Saarrah Ray
DPhil in Law candidate, University of Oxford. Saarrah’s thesis explores radical feminist legal arguments reconceptualising Female Genital Cosmetic Surgery as a form of violence against women and a variant of FGM/C.

References:

Ray, S. (2021). The Husband-Stitch: Could it be Female Genital Mutilation?. Available on: https://www.durham.ac.uk/research/institutes-and-centres/ethics-law-life-sciences/about-us/blogs/obstetric-violence-blog/the-husband-stitch/

Ray, S. (2024). Sister, Is this Mutilation?. Fem Leg Stud 32, 357–359. https://doi.org/10.1007/s10691-024-09553-0

The medicalisation of Female Genital Mutilation/Cutting (FGM/C) is an alarming global trend. Performed by health professionals under the guise of safety, it reinforces a practice that is widely recognised as a violation of human rights. In reality, medicalisation neither eliminates harm nor erases the oppressive cultural roots of FGM/C.

These and related issues were explored in the 4 April 2025 webinar “Understanding the Medicalisation of Female Genital Mutilation/Cutting (FGM/C): Impacts, Challenges, and Solutions”, hosted by the Asia Network to End FGM/C and Equality Now. Experts from Asia and Africa addressed the scope of the practice, the shifting responsibility to healthcare professionals, and the barriers to transformative change.

A Global Practice, an Overlooked Asian Reality

FGM/C continues in over 90 countries, affecting 230 million women and girls worldwide (UNICEF, 2024)[i]. While often associated with Africa, 80 million of these cases are from Asia. The practice is prevalent in Indonesia, Malaysia, Singapore, Sri Lanka, Brunei, Thailand, the Philippines, the Maldives, India, and Pakistan. In many Asian countries, Types I and IV, considered less severe, are dominant. However, this perception has contributed to the practice being overlooked in global discourse (ARROW, 2020)[ii].

Despite progress at policy levels, including the SDG commitment to eliminate FGM/C by 2030, current efforts need to be 27 times faster to meet this goal (UNICEF, 2024)i. The practice persists largely due to misinformation, community resistance, and a lack of political will.

Quiet advocacy: The role of healthcare professionals

Healthcare professionals are increasingly implicated in the continuation of FGM/C. Dr. Hannah Nazri emphasises that advocacy isn’t limited to high-profile actions like lobbying or public campaigns—it can be quiet yet powerful. Routine patient interactions, education, workshops, and contributing to clinical guidelines are all meaningful forms of advocacy. Social media can amplify these efforts, but impactful advocacy doesn’t have to be loud to be effective.

That said, many doctors are overwhelmed by the demands of day-to-day clinical work, leaving little time or energy for broader advocacy efforts. Heavy workloads, long shifts, and administrative pressures can make it difficult to engage beyond immediate patient care, even when clinicians care deeply about issues like FGM/C. 

Advocacy within clinical settings also involves navigating complex social and ethical terrain. In societies where FGM/C is socially accepted or not criminalised, healthcare professionals may feel pressured to stay silent—or even comply. Dr. Nazri highlights that junior doctors in such contexts often struggle to challenge senior colleagues who support the practice, creating ethical dilemmas and limiting space for resistance. 

They must be meaningfully supported in their professional environments to realise their potential as effective advocates.

She also underscores the importance of cultural literacy. Marginalised communities experience structural exclusions that shape their access to care and health decisions. As Dr. Nazri notes, advocacy approaches must be context-specific—what works in one region may not apply elsewhere. For example, research in Malaysia shows many Muslim women who have undergone FGM/C report fulfilling sexual lives and reject dominant narratives linking the practice solely to sexual disempowerment (Isa et al., 1999)[iii].

Rising Medicalisation: Urban and Institutional Trends

The assumption that medicalisation is more common in rural areas is misleading. As societies begin to recognise the harms of traditional forms of FGM/C, medical professionals are increasingly taking over. In Malaysia, 20.5% of doctors admitted to performing Type IV FGM/C, typically involving pricking and needling, and some to performing Type I (Rashid et al., 2020[iv]). In Indonesia, healthcare workers conducted incision (26%) and excision (52%), often more invasive than traditional attendants who used scraping or symbolic cutting (Budiharsana, 2016[v]; Hidayana, 2024 [vi]).

Dr Nazri also warned of early signs that FGM/C is becoming medicalised. These include incorporating the practice into delivery packages, shifts in community narratives that frame it as “safer,” and informal medical training outside regulated curricula. She argued that regulatory gaps enable the quiet normalisation of medicalised FGM/C and highlighted the need for legal and ethical clarity.

Community-based strategies are essential to disrupting this trend. Dr Nazri advocated for engaging local influencers and religious leaders through culturally appropriate education, storytelling, and community health programmes. She noted that effective advocacy often happens when FGM/C is discussed as part of broader public health dialogues, not as a stand-alone issue.

Investing in Change: Education, Ethics and Legal Gaps

While some may argue that medicalisation reduces physical risks, Dr Nazri underscored that it gives the false impression of legitimacy. Ministries of Health and medical associations often remain silent, creating policy ambiguity and weakening enforcement.

The conversation also touched on how students and early-career professionals can contribute to change. Dr Nazri advised students to collaborate with advocacy organisations, organise educational events, and engage with academic supervisors on FGM/C research. For long-term impact, curriculum reform is crucial, especially for midwifery and healthcare education. She proposed that norms change be embedded into training, supported by mentorship and real-world engagement with communities.

Medicalised FGM/C is often passed down through informal channels, without any formal guidelines. Dr Nazri clarified that the lack of regulation has led to varied practices, and any effort to formalise procedures would risk legitimising them.

The medicalisation of FGM/C exposes a critical fault line in global health advocacy. While healthcare professionals can be powerful allies in ending the practice, they also risk perpetuating it in the absence of clear guidance and cultural accountability. The April 2025 webinar made it clear: dismantling FGM/C requires a united effort across legal, medical, and community platforms. Every patient interaction, every educational initiative, and every policy reform must push toward one goal, eradicating FGM/C in all its forms.

Speaker Profiles

Professor Samuel Kimani
Associate Professor, Faculty of Health Sciences, University of Nairobi. With over 20 years of experience in global health, medical training, and research, Professor Kimani is a leading expert on FGM/C in Africa.

Dr Hannah Nazri
NIHR Academic Clinical Fellow in Obstetrics & Gynaecology, University of Warwick. Director of Malaysian Doctors for Women & Children. Dr Nazri works internationally to end FGM/C through education, policy engagement, and healthcare leadership.

Saarrah Ray
DPhil in Law candidate, University of Oxford. Saarrah’s thesis explores radical feminist legal arguments reconceptualising Female Genital Cosmetic Surgery as a form of violence against women and a variant of FGM/C.

References:

1.  Unicef (2024). Female Genital Mutilation: A global concern. https://data.unicef.org/resources/female-genital-mutilation-a-global-concern-2024/
2.  Asian-Pacific Resource and Research Centre for Women (ARROW) and Orchid Project, 2020. “Asia Network to End Female Genital Mutilation/Cutting (FGM/C) Consultation Report,” 2020, https://bit.ly/3lz5O4w. 
3.  Isa, Ab. R., Shuib, R., & Othman, M. S. (1999). The practice of female circumcision among Muslims in Kelantan, Malaysia. Reproductive Health Matters, 7(13), 137–144. https://doi.org/10.1016/S0968-8080(99)90125-8
4.  Rashid, A., Iguchi, Y., & Afiqah, S. N. (2020). Medicalization of female genital cutting in Malaysia: A mixed methods study. PLOS Medicine, 17(10).
5.  Budiharsana, M. (2016). Female genital cutting common in Indonesia, offered as part of child delivery by birth clinics. The Conversation. https://theconversation.com/female-genital-cutting-common-in-indonesia-offered-as-part-of-child-delivery-by-birth-clinics-54379
6.  Hidayana, I. M. (2024). The Medicalization of Female Genital Cutting (FGC) in Indonesia: A Complex Intersection of Tradition, Religion, and Human Rights. Current Sexual Health Reports, 16(4), 217–220. https://doi.org/10.1007/S11930-024-00393-2/FIGURES/1

Join us as we learn about FGM/C in the Bangsamoro region in the Philippines through the lens of a homegrown activist, Fatima Allian @ Shalom.

1. Share with us about your organisation and its work surrounding FGM/C

 Nisa Ul Haqq Fi Bangsamoro Inc. or Women for Justice in the Bangsamoro is a group of Muslim women NGO leaders advocating for women’s rights in the context of Islam and culture. In 2019 Nisa was invited FGM/C as part of an exploratory research in the Bangsamoro region. This was initiated due to the dearth of data on both FGM/C practices and its impact on women and girls in Bangsamoro. This is the first FGM/C  in- depth research in the Bangsamoro region. 

2. What are some latest important finding on FGM/C in Bangsamoro?

Type of FGM

Bangsamoro girls as young as two months old and older women as old as late 20s are subjected to type IV. Blades, bamboo sticks, small knives,needle nail-cutting knives and cotton are interchangeably used depending on the traditional birth attendants’ (panday) preference.

Medical Practitioners and Government leaders

In the research, all the medical practitioner key interviewees strongly believe that this tradition is Islamic. Medical practitioners not only encourage this practice as it is deemed as a religious obligation, but they also enable the perception that FGM/C can control the haram of lustfulness. Ultimately, the medical profession also reflects the bigger social norm that puts FGM/C as a way to prove one’s strong dan devoted faith to Islam.

Economic implication for non-circumcised Moro and revert women

Social stigma against Moro and revert Muslim women who are not cut or circumcised will bear the cost financially as the community will stop buying from them as their businesses are deemed haram. 

Deprivation of quality of childhoods and life

This practice is silently signaling the immediate  transition from childhood to puberty indicating her readiness for womanhood despite her very young reproductive age. That at the onset of her menarche,  limits her opportunity to advance self development for her future and puts her at risk for reproductive health related problems due to betrothal arrangements of the elders.

3. As a field researcher, what was your key takeaway when engaging with the community throughout this study? 

This research reminded me of the differences that exist within the communities. Our Bangsamoro girls and women’s lived realities should be acknowledged and documented so researchers and lawmakers have a better idea to formulate impactful and survivor sensitive policies that will benefit and protect them optimally.

4. How has the COVID-19 pandemic impacted FGM/C in the Philippines? 

On policy formulation and advocacy work against the practice of  FGM/C, we were not able to sustain the momentum after the presentation of the research with selected Ministries and members of the parliament due to the first (2020) and second (2021) wave of the pandemic in all areas of the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM).

5. Who are the key stakeholders to engage as allies in anti-FGM/C advocacy in the Philippines, and how should we engage with these groups? 

The potential allies are policy makers of the BARMM, senate and congress' women, children , education and health committees respectively,  religious leaders , academic institutions,  peace builders and peace makers, SRH and human rights  network organizations. Exploring engagement activities such as series of dialogues, presentations of research and formulation of  policy papers that can popularise strong  anti FGM/C advocacy and lobbying works in the country. 

6. In your experience, how can CSOs and grassroots organisations working on FGM/C engage donors or the international community to fund community-led research? 

Utilising the political track of the peace processes between the government of the Philippines and the Moro Islamic Liberation Front and the national elections in 2022 is an entry point as well. This shall leverage FGM/C a national issue of concern in combating SRH implications, protecting the bodily integrity of women and girls and ending child marriages. 

7. Why is it so important to have a network such as the Asia Network to support activists in the region? How can the Network help to increase awareness of FGM in Asia? 

There is power in numbers and that is definitely helpful in creating ripple effects in any advocacy and lobbying work. When policy makers and donor communities feel our presence in different parts of the world calling for an end to a harmful traditional practice, they cannot afford to recognise the call to end FGM/C as a form of human rights violation against women and girls.  There is a need to strengthen the call using IEC online and other platforms such as social media and academic institutions. The network can engage with the community partners of activists to develop sharper gender lens and understanding on Islamic rulings on FGM/C. The  production of IEC in local languages used in the madaris, community dialogues and local radio programs encourages activists to articulate effectively in engaging with local, national and regional policy makers and donor communities.

We spoke to the creative team behind the Asia Network’s branding to get a glimpse behind the scenes! Read on to learn about the design process of the Asia Network’s logo and website.

Nicolette Mallari is a freelance graphic designer and creative consultant from the Philippines. Getting to work on projects with a higher purpose and collective scope provides her the opportunity to contribute to social transformation – this has been her approach to publication and information design for clients like ARROW. Nicolette designed the logo of the Asia Network, working in consultation with ARROW and Orchid Project.

Why did you decide to take on this project?

I am more than happy to take on projects that have an impact on human rights, and women and girls’ SRHR.

Of all the graphic design disciplines, visual identity is the yardstick of a designer’s skill set. Much more than a merging of shapes, colors, and fonts to create an aesthetic, logos need to be able to express a visual narrative in the simplest and clearest of terms. The project for the Network started off with a design brief from the client, who outlined the purpose and objectives of the organisation. Design briefs are critical for designers, these provide focus and direction for the concept and outputs. Given the nature of the project, the Network also provided a shortlist of visuals to avoid.

What was the inspiration behind the logo design? What do the different elements symbolise and how did you choose the colour palette? Could you share a little more about the ideation/design process? 

THE CONCEPT

Before the mouse hits the pad, the pencil hits the paper. This meant research – symbols, shapes, typefaces, colour themes – anything that would consolidate the message, values, and visions of the organisation into a graphic element was noted and sketched out. One of those concepts was a flower, long used as a symbol of femininity, fertility, and health.

REFINING THE CONCEPT

The next challenge was to render the flower with clean, flowing lines and give it a recognisable figure. The final logo render is charismatic yet visually effective: a flower in full bloom – with petals resembling wings, and its stigma and ovule shaped to gently resemble female genitalia.

DEFINING THE COLOR PALETTE

The colours in the palette were carefully chosen to reflect the identity of the organisation. Specific color tones were requested in the creative brief. Teal green for its positive connotations in Islam; purple, as a nod to ARROW and the Orchid Project, and to the wider feminist movement, many of which have  purple in their logos; and yellow, for its sheer vibrance, is a symbol of hope and enlightenment.

Your hopes for the Asia Network to End FGM/C.

Like a flower in full bloom, may the Asia Network be the hope and renewal for women and girls.

The Silver Kick Company (TSKC) is a Bahrain-based creative agency with a big heart. The bright, young team have a burning passion to make the world a better place through the work they do, helping compassionate brands make an impact. We spoke to Maria Shaheen, the Digital Marketing Manager at TSKC. She handles everything digital: social media marketing, emails and newsletters, and website design and development.

Why did TSKC decide to take on this project?

The founder & CEO of the company, Shabana Feroze, is a survivor of FGM/C. So for her, anti-FGM/C projects are very close to her heart. As a company that believes strongly in being compassionate, we want to do whatever we can to help bring positive change to the world. Which is why we support non-profits in creating marketing material for their campaigns, workshops, events, and digital media. Whether it's pro-bono work or working on grants, we want to do whatever we can to help strengthen their voice!

What was the inspiration behind the layout and design of the website? What do the different elements/illustrations symbolise?

We mostly took inspiration from the amazing logo. (We shared the logo with our entire team because it’s so beautifully done. Kudos to the logo designer!).

Our design brief was super clear from ARROW and Orchid Project, which always helps! So we wanted to make an attractive, user-friendly website with vibrant colours to stand out from others in this field. Especially since this issue is a serious one, we don’t want to put people off from going through the website because it might be depressing or alarming to read information about FGM/C. With the Asia Network’s guidance, we chose illustrations that portray women from different ethnicities to make sure we include all communities that practice FGM/C. We used illustrations that create an impact and depict strong and empowered women.

All in all, the website depicts hope. That even though FGM/C is so prevalent, coalitions like the Asia Network won’t stop working to end it.

Your hopes for the Asia Network to End FGM/C.

We hope that by becoming more structured and raising more voices with other non-profits, the Asia Network can help stamp out FGM/C in our lifetime. No more women and girls should be subjected to this gender-based violence.

We hope to see harmful social norms and traditions changing because of the work the incredible members of the Asia Network do. And we hope we can help them in their journey.

by ARROW

Activists from around the world are calling on governments and members of the public to take action to support an end to female genital cutting. 

Cutting impacts at least 200 million women and girls, in over 45 countries across Africa, Asia, the Middle East, and within diaspora communities worldwide. It is a truly global issue, which presents multiple, complex challenges within each different context where girls are affected.

The good news is that committed activists, grassroots organisations, communities, NGOs and, increasingly, governments are turning towards this issue. Together we are presenting solutions as to how we can protect girls and allow them to thrive, free from the practice.

We are seeing significant progress. UNICEF reports that a girl is around one third less likely to be cut today than she was three decades ago. More and more, communities are deciding to leave cutting behind, but there is still so much more to be done.

On the International Day to End FGC 2019, Orchid Project brought three esteemed guests together to speak live on Facebook about the global movement to end cutting, and the challenges that we still face.

We were joined by Sivananthi Thanenthiran, Executive Director of The Asian-Pacific Resource and Research Centre for Women (ARROW), based in Malaysia, Wairimu Munyinyi-Wahome, Executive Director of the Coalition on Violence Against Women (COVAW) in Kenya, and Mariya Taher, Co-Founder of transnational Indian & US organisation, Sahiyo.

They called for governments and members of the public to take action and support an end to this harmful traditional practice.

Together with Siva, Wairimu and Mariya, we call on governments to:

• Engage meaningfully with custodians of the practice, such as cultural and religious leaders.
• Report on UN Sustainable Development Goal Indicator relating to cutting (5.3.2).
• Provide dedicated budgets and resources towards ending the practice.
• Support greater data collection on the practice at national, regional and local levels.
• Engage, support and partner with grassroots, community-led initiatives.
• Recognise cutting as a global issue, particularly in contexts such as Malaysia where it is not yet acknowledged.
• Approach cutting as a human rights issue, acknowledging that all forms of the practice are a rights violation, and harmful to women and girls.

…and for members of the public to:

• Elevate the voices of women, girls and communities affected by cutting on platforms like social media.
• Share and talk about the practice with friends, family and colleagues to raise awareness.
• Write to local and national representatives, asking them to support change.
• Support, volunteer and donate to organisations working to end FGC.
• Stay up-to-date with organisations working to end the practice, such as Sahiyo, COVAW, ARROW and Orchid Project.
  
  

By: Orchid Project