Female genital mutilation (FGM) refers to all procedures involving the partial or total removal of female external genitalia or other injury to the female genital organs for non-medical reasons. Member states of the United Nations (UN), civil society organizations, professionals, and activists have invested in major efforts to eliminate FGM due to its harmful effects on girls and women, including the violation of personal rights, gender inequality, and compromised health and education. Indeed, the global community has prioritized the elimination of FGM, as reflected in the UN Sustainable Development Goals (SDGs), which aim to transform the world by ensuring that all people enjoy health, justice, and prosperity.
However, the impacts of such interventions toward FGM elimination have been mixed, with varying levels of success across countries. The lack of sufficient progress in combatting FGM threatens to undermine the SDG of eliminating FGM by 2030. FGM has been documented in 92 countries, and untold numbers of girls remain at risk of being cut. To date, an estimated 230 million girls and women live with FGM worldwide, an increase of 30 million since 2016. This rise is mainly attributed to population growth in countries with nationally representative data on FGM, as well as the inclusion of women in diasporas living with FGM who were previously uncounted.
This article examines the challenges and progress in eliminating FGM globally. It begins with an overview of FGM prevalence and trends before discussing the effectiveness of FGM legal prohibitions and the cultural and religious pushbacks against these laws. Finally, the article advocates for FGM policies and programs that better account for population growth, health, and legal shifts. It also emphasizes that stakeholders’ engagement can prevent legal policy pushbacks and promote sustainable interventions. These insights can help policymakers, funders, and programmers support the elimination of FGM.
Magnitude and Patterns of FGM
Globally, girls are increasingly being subjected to FGM at younger ages. In fact, approximately 4.3 million girls are at risk of being subjected to FGM every year. This shift is partly due to interventions targeting older girls, awareness-raising campaigns highlighting FGM’s health risks, efforts to frame FGM as a human rights violation, and the increasing legal prohibition of the practice. Through community structures such as civil society organizations, schools, and religious institutions, these interventions have empowered older girls to resist FGM by seeking refuge in safe havens or threatening to report their parents to law enforcement. Consequently, families often opt to cut younger girls who are less informed, less able to resist, or lack protection. This trend calls for interventions focused on protecting younger girls, such as working with young parents in liaison with children’s officers, early childhood teachers, and caregivers.
Furthermore, Africa continues to bear the brunt of FGM, which is most common in the lateral belt stretching from West Africa to the Horn of Africa. Countries with an FGM prevalence above 80 percent include Somalia (99 percent), Guinea (95 percent), Mali (85 percent), Sudan (87 percent), Egypt (87 percent), Sierra Leone (83 percent), and Eritrea (83 percent). However, FGM prevalence has declined by over 30 percent in several countries, including Sierra Leone, Ethiopia, Burkina Faso, Liberia, Kenya, Nigeria, Tanzania, and Benin. Nonetheless, little progress has been made in Somalia, Mali, Gambia, Guinea Bissau, and Senegal.
Analyses show that intra-country ethnic variation in FGM prevalence, the persistence of sociocultural norms, and structural challenges drive regional disparities in FGM abandonment. The insights from these analyses call for sustained and targeted engagement with FGM-practicing communities informed by an in-depth understanding of the complex social cultural and structural factors that support the practice.
One of the consequences of the high prevalence of FGM in Africa is that many migrants to countries across Europe, North America, and elsewhere have experienced FGM, a phenomenon known as diaspora FGM. To date, approximately one to two million girls and women in the Global North are living with FGM, largely due to emigration and asylum-seeking driven by instability, conflict, and crises in Africa, as well as the search for socioeconomic opportunities. Instability has disrupted protection systems against FGM in migrants’ home countries, and receiving countries now face the significant challenge of providing protection systems to safeguard the next generation of girls from this practice.
States should strengthen the relevant health and social care systems to offer services that mitigate the health and psychosocial effects of FGM on women and girls. Duty bearers and service providers should build the capacity to provide culturally sensitive and competent services while addressing the discrimination that FGM survivors and their families often encounter. Evidence shows that health and social service providers need training on handling, caring, and communicating with survivors of FGM to prevent re-traumatization. Furthermore, governments should invest in FGM interventions that adopt a human rights approach, particularly in high-prevalence countries.
Legal Outlook of FGM
Many countries have enacted legal prohibitions against FGM, reflecting a conducive political environment for FGM elimination. Approximately 88 countries have prohibited FGM through specific laws or by incorporating criminal provisions in other domestic laws, such as criminal or penal codes, child protection laws, violence against women laws, and domestic violence laws. In Africa alone, 28 countries have enacted specific laws or legal provisions prohibiting FGM. Such laws demonstrate government commitment to ending FGM and underscore the international consensus that FGM is a violation of human rights. Additionally, these laws lay a strong foundation by which other FGM-related interventions can be established. Framing FGM as a criminal offense can deter the practice and sensitize communities through education and awareness-raising, thereby contributing to behavioral change.
However, local dynamics such as the notion that FGM confers cultural and religious identity have driven pushback against the legal prohibition of FGM. Some believe that prohibitions undermine their community’s cultural and religious beliefs, which also drive the practice of FGM.
In 2024, the Gambian religious leaders and some politicians attempted to reverse the landmark ban on FGM. Advocates for the law’s repeal claimed that the ban violated citizens’ right to practice their culture and religion. This pushback mirrors Kenya’s 2019 Dr. Tatu Kamau petition, which challenged the constitutionality of the Prohibition of Female Genital Mutilation Act of 2011 on the basis that outlawing FGM infringes on adult women’s right to participate in their culture and religion. However, the High Court of Kenya ruled that FGM remains illegal in Kenya based on its consequences for human rights and health. Nonetheless, these instances of legal pushback highlight the complex realities of cultural context and legal frameworks calling for a multifaceted approach to eradication of FGM.
Medicalization: A Growing Risk
In addition to legal pushback, some harm reduction-focused efforts to eradicate FGM have facilitated medicalization which threaten to perpetuate FGM by healthcare professionals in clinics, hospitals, or at home. The World Health Organization (WHO) defines medicalization as situations in which FGM is practiced by any cadre of healthcare workers in a public or private clinic, at home, or elsewhere at any point in a woman’s life. It also includes re-infibulation (the reclosing of external genitalia once a woman with infibulation has been opened up for birth, consummation of marriage, or other gynecological procedures) for non-medical reasons. Medicalization is often considered a “safer” form of FGM because it is less severe, mitigates immediate health risks, aligns with community norms, avoids legal issues, and provides financial incentives. However, medicalization does not address the long-term complications associated with FGM such as psychological trauma, and it fails to address FGM as a human rights violation.
The continued demand for FGM, despite changes in societal norms and legal restrictions, has contributed to the growth of medicalized FGM. For instance, marriage is often one of the few avenues for securing the future well-being of girls in places where structural challenges such as poverty and inadequate education are widespread. Therefore, when matrimonial prospects are linked to FGM, the price of foregoing FGM can be impossibly high, forcing communities to resort to medicalized FGM. Evidence shows more than 90 percent of women who experienced FGM performed by healthcare professionals are in Egypt, Sudan, Guinea, Kenya, and Nigeria.
In some jurisdictions, anti-FGM policies have inadvertently promoted medicalization rather than banning the practice. For instance, regulations issued by government ministries of health in Egypt in the 1990s and Indonesia in the 2000s authorized specific healthcare professionals in designated facilities to perform FGM. While the intent was to minimize negative health complications, human rights activists argued that these policies perpetuated human rights abuses and gender inequality. While these criticisms eventually led Egypt and Indonesia to repeal their medicalization policies, the infrastructure and practitioners for medicalized FGM remained. These initial legal policy decisions may help explain the high rates of medicalization observed in the two countries.
Interventions for medicalization should focus on disrupting the demand side—families and communities—and the supply side—healthcare workers. National ministries of health and activists should engage with professional regulatory bodies and associations to raise awareness of the prevalence of medicalization and healthcare professionals’ role in its elimination. Professional regulatory bodies and associations should build capacity by improving the training of health workers, emphasizing adherence to the ethical principles of “do no harm” and “safeguarding,” and educating patients on the human rights principles that undergird the imperative to end FGM.
Conclusion
To reduce the prevalence of FGM, stakeholders should deeply consider population growth, health, and legal shifts in the design and implementation of FGM-related interventions. Population growth matters because it increases the number of girls at risk of FGM even if prevalence declines. Furthermore, global bodies of medical doctors, nurses, and midwives should commit to ending FGM and adopting a “zero tolerance” policy toward medicalization, a practice that undermines ethical principles and abets FGM. Finally, stakeholder engagement is critical in preventing legal policy pushbacks that stem from strong religious and cultural beliefs. By increasing stakeholder engagement and involving community members in decision-making, policymakers can create sustainable legal instruments that reconcile cultural and human-rights approaches to ending FGM. This approach also facilitates the decolonization of FGM interventions by dispelling the notion that these efforts are externally imposed. By adopting a multifaceted approach, the global community can work towards the complete eradication of FGM and protect future generations of girls and women.
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Samuel Kimani is an Associate Professor at the University of Nairobi, Kenya, where he teaches Global Health and Nursing. His work focuses on interventions addressing harmful practices affecting children, girls, and women. Particularly, his research focuses on evidence-based interventions on the medicalization of female genital mutilation and health system readiness towards FGM prevention and response. Email: tkimani@uonbi.ac.ke.
Amadou Moreau is a Population Scientist and Academic Entrepreneur. He is the Founder of Global Research and Advocacy Group (GRAG), a not-for-profit organization whose vision is to harness the power of research innovation and become a leading organization dedicated to advancing the evidence base for behavior change that can be used to inform programs or policies throughout sub-Saharan Africa. He is distinguished in developing, testing, and disseminating scalable interventions for vulnerable populations and has led extensive programmatic research including FGM/C, maternal death, and child protection in Senegal among other countries in Africa. Email: amoreau@globalresearchandadvocacygroup.org.
Bettina Shell-Duncan is a Professor at the University of Washington, Seattle where she teaches Medical Anthropology. She has extensively researched social norms underpinning female genital mutilation (FGM), medicalization, social norm change, and the effects of legal reform strategies. Particularly, her research work has focused on evidence of demographic patterns of FGM as well as social change efforts in Kenya, Senegal, and The Gambia. Email: bsd@uw.edu.
Image credit: Ttarimin, CC BY-SA 4.0, via Wikimedia Commons
