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Healthcare at a Crossroads: Confronting the Medicalisation of FGM/C

Blogpost

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
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