Creating Effective Communication:

The following steps will help ensure the comfort and security of the female patient or client:

• Create a welcoming environment
  • Make sure dialogue is comfortable and open
• Use appropriate language and terminology
  • Read more about this by clicking here
• Remember that FGM is only one part of a girl or woman’s life
  • Not all girls and women living with FGM have health complications related to the practice
  • Consider other physical or emotional needs before discussing FGM in detail
• Ensure confidentiality
  • Girls or women may not want to disclose their FGM status
  • Avoid discussing FGM in a public place such as a reception area (1)
• Use a professional yet amiable tone 
  • Tell the patient that you are familiar with and knowledgable about FGM
  • Do not whisper to the patient (as if the subject were shameful)
  • Do not express extreme pity or disapproval (this may come across as judgemental)
• Listen closely to the patient 
  • Your role is to guide the discussion by asking open-ended questions and then listening attentively to the patient
  • Avoid giving too much information in the first conversation – may decrease effective communication
• Do not push the patient to discuss details 
  • Allow the patient to naturally open up
  • If the patient does not want to discuss the matter, give her time and display your understanding

Female-Centered Care Within the Family Context:

The support you provide to women or children living with FGM is best determined by her needs and wants. This means whenever possible, encourage her autonomy and give her the chance to make informed and independent decisions. Be aware that women are often closely linked to their family environments. In some cultures, a woman’s decision is expected to include the input and approval of family members, especially her husband. It is crucial to understand that others may have a direct influence on her decisions.

Whenever possible, empower the client to make her own decisions on whether she wants to release information to her family. It is for this reason that minors have special rights when it comes to medical consent regarding their own sexual health (2). A good way to determine if the female wants to decide individually or involve other family members is by asking her in private. Involving the partner or family may be a good opportunity to empower and engage the whole family, yet it may also take away from the female patient’s autonomy. Support whichever decision she makes (1).

Every situation is complex and unique. Professionals involved in FGM investigations are encouraged to coordinate efforts, think ahead, and consider all factors.

Sensitivity:

Understanding cultural beliefs behind FGM:

The sociocultural factors for performing FGM differ between regions. The most common reasons include (3):

• RESPECT FOR TRADITION
  • FGM is seen as part of the history and cultural tradition
• SOCIAL CONVENTION
  • Those who do not practice FGM may be ostracized from community
• RITE OF PASSAGE
  • FGM is an important rite of passage into adulthood for girls 
• ENHANCE FERTILITY
  • Some communities believe that if a woman is not cut, she will not be able to become pregnant 
• MARRIAGEABILITY
  • Often an expectation that men will marry only women who have undergone FGM
• ENSURE VIRGINITY, CHASTITY AND FAITHFULNESS
  • FGM is seen to protect a girl’s or woman’s virginity prior to marriage and establish fidelity after marriage
• CLEANLINESS AND BEAUTY
  • Female genitals that are cut are often seen as more hygienic 
• FEMININITY
  • Removal of “masculine” genitals parts (i.e. the clitoris) is considered to make girls more beautiful
• RELIGION
  • Predominant in Muslim communities
  • Many communities believe that FGM is a religious requirement, yet it is not mentioned in the Bible, Quran, or Hebrew Bible

FGM Terminology:

A contextual use of terminology should be applied when working with a female patient. Here are common FGM terms and their implications (4):

• “Female Genital Mutilation”:
  • “Mutilation” reinforces that the practice is a violation of girls’ and women’s rights
  • Promotes national and international advocacy for FGM abandonment
  • Establishes clear distinction from male circumcision
  • Widely accepted term

• “Female Genital Cutting”:
  • Often used among practicing communities and individuals
  • Reflect importance of using non-judgmental terminology 

• “Female Circumcision”:
  • Should be avoided since it draws a parallel with male circumcision and thus creates confusion between these two different practices

• Cultural Competency:
  • A survivor or members of FGM-affected communities should be asked which term she or they prefer
  • Different communities and cultures will use different terms when discussing FGM

Empowering Terminology:

• “Victim” vs. “Survivor”
  • Mainstream the use of the term survivor instead of victim to empower the patient
  • A girl or woman should be asked which term she prefers to use
• “FGM-affected communities” vs. “FGM-practicing communities”
  • FGM-affected communities conveys a more comprehensive understanding of the impact of FGM on communities than the more neutral FGM-practicing communities

Accuracy: 

• Educate yourself about FGM, including the risks, meaning of FGM “medicalization,” procedure, and cultural beliefs
• Understand the what, where, and why of FGM
• Recognize FGM as a human rights violation
• For more information, visit the page What is FGM?

References:

1. Toubia N. Caring for women with circumcision: a technical manual for health care providers. New York (NY): Research, Action, and Information Network for Bodily Integrity of Women (RAINBO); 1999.

2. Arik V. Marcell, Gale R. Burstein and COMMITTEE ON ADOLESCENCE (2017). Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics, 140(5). DOI: https://doi.org/10.1542/peds.2017-2858

3. Female genital mutilation. World Health Organization (https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation, accessed 19 July 2020)

4. Care of women and girls living with female genital mutilation: a clinical handbook. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.