Legislation should provide that rules, procedures and protocols for police, social service and child protection professionals, medical providers and the judiciary be adopted within six months of passage of the legislation in order that it may be quickly implemented. Protocols should include methods for initiating dialogue about FGM at various stages of providing health services. In addition, protocols should provide guidelines to assess the level of risk for a girl. Such guidelines can help avoid arbitrary and discriminatory assumptions and decisions.
Health Regulatory Measures
- Drafters should mandate that standards for medical ethics clearly state that the practice of FGM violates professional standards.
- Practitioners who perform FGM should be subject to disciplinary proceedings and lose their license to practice medicine.
- Legislation should also require education to health professionals on how to treat patients, especially pregnant women, who have undergone FGM.
- Legislation should explicitly state that re-infibulation, the “re-closing” of a woman after child birth to her infibulated pre-delivery state, is illegal and should now be performed by anyone in the medical sector.
Medical-Legal Advisory Body
Legislation should mandate the creation of an advisory body with members from the medical, mental health, and legal professions who can direct policy and monitor cases of FGM. This advisory body should be charged with the duty of identifying existing and new harmful practices to women which may be hidden in the community, and with developing a plan to educate, prevent, and prosecute with such harmful practices in mind. Legislation should mandate funds for the collection of sex-disaggregated data on FGM.
Illustrative Examples:
- Denmark – The National Board of Health declared that it was illegal for doctors to perform FGM because it was not medically necessary. The Danish Medical Women’s Association also provides health professionals with information about how to treat patients who have undergone FGM. (See: Female Genital Mutilation: A Guide to Laws and Policies Worldwide, Denmark)
- Egypt – A 1996 order from the Minister of Health and Population prohibited the practice of FGM for any non-medical purpose, including both public and private clinics. The decree stated:
Order No. 261 of 8 July 1996 of the Minister of Health and Population:
It is forbidden to perform circumcision on females either in hospitals or public or private clinics. The procedure can only be performed in cases of disease and when approved by the head of the obstetrics and gynecology department at the hospital, and upon the suggestion of the treating physician. Performance of this operation will be considered a violation of the laws governing the medical profession. Nor is this operation to be performed by non-physicians.
The decree was challenged but upheld by the highest administrative court and cannot be appealed. When issuing its ruling, the court declared that Islam does not require or sanction the practice of FGM and that the practice is a violation of Egypt’s Penal Code:
With this ruling everybody is banned from performing [FGM], even with the proven consent of the girl or her parents, except in cases of medical necessity, which must be determined by the director of the gynecology department in one of the hospitals. Otherwise, all those who do not comply will be subjected to criminal and administrative punishments.
See: Egypt: Highest Court Upholds Minister's Ban on Female Genital Mutilation (FGM) Equality Now, Women’s Action, Vol. 8, No. 4, Feb. 1998
In addition, in June 2007, the Ministry of Health of Egypt adopted decree no 271 outlawing FGM. The decree closed a loophole in the previous 1996 decree no 261, which prevented medical practitioners from performing FGM in governmental facilities and private clinics, but did not legally ban the performance of FGM in a home by a non-governmental medical practitioner. In addition, amendments were made to Child Law 12/1996 in June 2008, including the addition of a new clause to Article 7. The clause banned the practice of female genital mutilation and provided for a fine of 1,000-5,000 EGP or imprisonment for three months to two years for anyone convicted of performing FGM. (See: Universal Periodic Review – Human Rights Council: UNICEF Inputs – Egypt, Para. 5.1.3.)
CASE STUDY: American Academy of Pediatrics Retracts Endorsement of “Ritual Nick”
In an April 2010 policy statement issued by the American Academy of Pediatrics (AAP)’s Committee on Bioethics on Ritual Genital Cutting of Female Minors, the Committee offered a “ritual nick” as a compromise to more extensive forms of female genital mutilation. Although the Committee condemned FGM as an extremely risky practice with long-term negative health consequences, it stated that a “ritual nick” may be a way to build trust between hospitals and immigrant communities and avoid greater harm to girls.
The initial policy statement received widespread criticism from advocacy groups and survivors of FGM. Such groups expressed concern that the policy statement was likely to increase confusion on the issue for Academy members, and for the immigrant communities who deserve full protection of US laws, including a 1996 federal law which prohibits any practice of female genital mutilation. The AAP’s initial statement legitimized the harmful practice of FGM under the guise of cultural sensitivity. Violations of human rights must never be excused in the name of culture. Customary or religious traditions, which often have the subordination of women at their root, may not serve to justify harmful practices. Advocacy groups called on the AAP to support the best interests of its most vulnerable patients by fully and roundly condemning all practices of female genital mutilation.
In a statement released in May 2010, the AAP reversed its initial position and expressly stated that any form of nicking or pricking the clitoris by medical professionals will not be encouraged or condoned. AAP President Judith S. Palfrey explained that the organization rescinded this policy "because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere else in the world." (See: Pediatricians Now Reject All Female Genital Cutting, CNN News (27 May 2010))
Immigration Services
Legislation in countries that receive immigrants from populations that regularly practice FGM should require that immigration services compile and present information on the harmful effects of FGM and the legal consequences of its practice to entering immigrants.
For example, the United States Citizenship and Immigration Services is required by law to provide information about FGM and the legal consequences of practicing FGM in the United States to immigrants and non-immigrants entering the United States from countries where FGM is widely practiced: 8 USC §1374 (2005) Information regarding female genital mutilation (See Immigration and Asylum: Promising Practice: United States – Mandatory information to immigrant and non-immigrant entrants regarding FGM section above; See also Public Education Section)