Female Genital Cutting and Deinfibulation: Applying the Theory of Planned Behavior to Research and Practice

Deinfibulation Contextualized: Delicacies of Shared Decision-Making in the Clinic

“…Yet, the expectation that medical consequences are inevitable is often the unquestioned starting point. In the Target Article by Brady et al (2019), they refer to the WHO recommendation of deinfibulation, said to "prevent and treat gynecological complications" and maximize health, and they state that the procedure ought to be done to "alleviate the most pronounced physical effects of type III FGC, a cultural practice." Even though Brady et al stress the importance of open-mindedness and rapport in the clinical encounter, it is clear that they see deinfibulation as the desired outcome of the shared decision making between caregiver and patient.…”

“…But the clinical encounter ought to start with an unbiased clinical assessment of the individual case, in which the possibility that the patient does not need deinfibulation (at this point of her life) should be on the table. Consequently, before the conceptual model suggested by Brady et al (2019) is set in motion, caregivers should be encouraged to use their professional discretion in order to establish whether the patient before them is one that suffers from the infibulation or not. A recent study among Somalis in Norway showed that even though attitudes to FGC in general are negative in this group, already infibulated women may prefer to preserve their state of being infibulated until a later point in life, as long as they are doing fine: "[W]hereas many informants claimed that they would accept premarital defibulation in cases of severe health problems, they considered it socially unacceptable and thus not done except in rare cases" (Johansen, 2019, p. 15).…”

“…If this is not the starting point, there is a risk that paternalistic attitudes-warned against by Brady et al (2019)-will impact the encounter. If the conceptual model presented in the Target Article is launched with the ultimate motive of overcoming any possible reluctance to agree to deinfibulation, then a somewhat deceitful or manipulative attitude will be present during the encounter, and the patient will be implicitly reduced to a person who does not understand her own interests.…”

“…The proposed model for clinical conversations about infibulation that Brady, Connor, Chaisson, Mohamed, and Robinson (2019) present in their Target Article encompasses a refreshingly nonjudgmental approach to dealing with deinfibulation as a clinical phenomenon and as an object of study. The merits of their approach are manifold: They recommend a truly sensitive and respectful attitude toward women with female genital cutting (FGC), and they highlight the urgency of seeing the wider context that may impact women's choices in order to promote shared decision making in clinical encounters.…”

“…Our overall point of view is thus very positive: We endorse the effort to create a framework that handles the question of deinfibulation with such nuance and respect for the affected girls and women. Our main concerns with Brady et al's (2019) Target Article regard how medical consequences of FGC are framed, as well as how their model and discussion disregard the importance of cultural change after migration and the effects of anti-FGM policies in Western countries.…”