Health care providers’ and mothers’ perceptions about the medicalization of female genital mutilation or cutting in Egypt: a cross-sectional qualitative study

Abstract

Background Female genital mutilation/cutting (FGM/C) is a traditional harmful practice that has been prevalent in Egypt for many years. The medicalization of FGM/C has been increasing significantly in Egypt making it the country with the highest rate of medicalization. In this qualitative study, we explored the drivers and motives behind why healthcare professionals perform FGM/C and why mothers rely on them to perform the practice on their daughters. Methods The study drew on a “mystery client” approach, coupled with in-depth interviews (IDIs) and focus group discussions (FGDs) with health care providers (i.e. physicians and nurses) and mothers. It was conducted in three geographic areas in Egypt: Cairo, Assiut and Al Gharbeya. Results Study findings suggest that parents who seek medicalized cutting often do so to minimize health risks while conforming to social expectations. Thus, the factors that support FGM/C overlap with the factors that support medicalization. For many mothers and healthcare providers, adherence to community customs and traditions was the most important motive to practice FGM/C. Also, the social construction of girls’ well-being and bodily beauty makes FGM/C a perceived necessity which lays the ground for stigmatization against uncut girls. Finally, the language around FGM/C is being reframed by many healthcare providers as a cosmetic surgery. Such reframing may be one way for providers to overcome the law against FGM/C and market the operation to the clients. Conclusion These contradictions and contestations highlighted in this study among mothers and healthcare providers suggest that legal, moral and social norms that underpin FGM/C practice are not harmonized and would thus lead to a further rise in the medicalization of FGM/C. This also highlights the critical role that health providers can play in efforts to drive the abandonment of FGM/C in Egypt. Electronic supplementary material The online version of this article (10.1186/s12914-019-0202-x) contains supplementary material, which is available to authorized users.

Medicalization of female genital cutting in Malaysia: A mixed methods study

“…The finding in this study that some doctors claimed harm reduction as their reason for practising FGC concurs with the findings of a review by Doucet and colleagues [ 12 ] and studies in Nigeria [ 26 ] and Egypt [ 27 ], where doctors practice FGC to prevent parents seeking traditional practitioners [ 16 ]. Religion and culture were motivations for the doctors in this study to conduct FGC just as in studies conducted in Nigeria [ 26 , 35 ] and Egypt [ 33 ].…”

“…There is no official training on FGC in the medical curriculum. Like most other health practitioners who perform FGC elsewhere, such as in Nigeria, Egypt, and Indonesia [ 26 , 27 , 34 , 35 ], the doctors in this study learned the skills from colleagues who themselves had no formal training. Unfortunately, parents who prefer their daughters be cut by healthcare professionals are unaware of the healthcare providers’ lack of knowledge and training related to FGC [ 32 ].…”

“…This finding also concurs with a review of literature by Doucet and colleagues [ 12 ] that found that FGC was justified for cultural reasons. Doctors who practiced FGC in this study were Malay Muslims who themselves were part of the community that they served, therefore some of them may have had the same religious, social, and cultural motivations as those who requested the service [ 27 ]. Some may have undergone FGC themselves or have maintained the tradition for their daughters [ 28 ].…”

“…It is reported that health practitioners fear social sanctions if they do not practice FGC especially in rural communities, where members of the community may boycott their practice, resulting in lower patient numbers and reduced income [ 27 ].…”

Female genital mutilation/cutting: Emerging factors sustaining medicalization related changes in selected Kenyan communities

“…This finding have been elicited elsewhere in Egypt where some doctors debated whether FGM/C was medically necessary and were using the term female genital cosmetic surgery. [39] Similarly, some clinician can hide behind the laws that legalize plastic surgery in Kenya to advance medicalized FGM/C as well as capitalize on the part of the definition for FGM/C under the prohibition of FGM Act namely "but does not include a sexual reassignment procedure or a medical procedure that has a genuine therapeutic purpose". [40] However, for this to happen medicalization must present a financially lucrative opportunity that may only be sustained by economically capable adult women as opposed to majority of girls who cannot afford the cost of surgeons.…”