Research gaps in the health care context have been described [2, 10], and there is room for additional research to address these gaps on topics including timing of de-infibulation, the effectiveness of perineal physiotherapy, the best prevention strategies for health care providers to undertake, coping with sexual and psychological difficulties, clitoral reconstruction outcomes, and many more.
Implementation issues in high prevalence and diaspora countries
There is some evidence that in many high prevalence countries the practice is decreasing, and also, that in countries with a high prevalence of type 3, infibulation is being replaced by less severe forms. However, the determinants of cessation of FGM/C remain elusive, and the process of abandonment varies from country to country. In diaspora countries as well, procedures vary extensively. Some have introduced mandatory reporting and recording. Others believe that such registration and reporting leads to stigma and that promoting trust with providers is more effective to bring about change.
Be it in high prevalence or diaspora countries, major controversies are present. For example, in some areas, health care providers perform FGM/C. This is known as medicalization, which is genital cutting by a healthcare provider in any setting and at any point in a woman’s life (2). Health-care providers increasingly carry out the practice mainly with the belief that health risks might be lower , and some stakeholders believe that medicalization is an intermediate and temporary step towards abandonment of FGM/C. However, WHO and more than ten other UN agencies and organizations released an interagency statement opposing medicalization of FGM/C .
Another debated topic is clitoral reconstruction, which in some diaspora settings is offered on a large scale without routine counseling and in others, in the context of careful counseling and psychosexual therapy that allow sometimes to meet the needs of women and go for surgery in few cases. Some health care providers consider clitoral reconstruction to be a right to regain something unjustly removed, while others are mainly focused on improving outcomes related to improved sexual function and reduced pain. While clitoral reconstruction can result in improved outcomes in some women, the safety and efficacy of the procedure is not yet known, and it is not clear whether and when the sexual counseling can also result in improved outcomes in the absence of surgery .
Another controversial topic relates to non-therapeutic genital surgery in adults. In general, in diaspora countries adult women who have undergone defibulation will be denied reinfibulation after giving birth, but the same women can access “genital cosmetic surgery”, which may even be covered through social security or insurance.
How getting together and sharing data and experience can help to advance the field
At present, even though research on prevention, treatment of FGM/C and training of healthcare professionals seems to be increasingly implemented in high prevalence and diaspora countries, little data and experience are shared or compared across countries. The recent guidelines of WHO on the management of FGM/C, in fact underlined the need for more research to improve the evidence base; multicenter research on the subjects like defibulation, clitoral reconstruction or mental and sexual health after FGM/C, and of evidence-based healthcare professionals training, in particular for reducing FGM/C “medicalization”.
This supplement to Reproductive Health contains the abstracts of key-note lectures, accepted oral presentations and e-posters from the international experts’ meeting titled “Management and prevention of female genital mutilation/cutting: sharing data and experiences, improving collaboration”, which took place at the Department of Obstetrics and Gynaecology of the Geneva University Hospitals (Geneva, Switzerland) in March 13–14, 2017. The meeting was organized by the G3 de la Francophonie (a consortium of three French speaking universities: Geneva (UNIGE), Brussels (ULB) and Montreal (UM)), in collaboration with the Department of Reproductive Health and Research of the World Health Organization. Additional support and funding was received from the Swiss Network against Female Genital Mutilation/Cutting (FGM/C), and the Geneva University Hospitals. Participants came from four continents and 23 countries.
The goals of this supplement are to share data, research initiatives and experiences of healthcare professionals, researchers and other experts, from diaspora and FGM/C high prevalence countries. These abstracts are classified along the three main themes of the two day conference: i) Healthcare professionals’ training and curricula / medicalization of FGM/C; ii) Healthcare and prevention of FGM/C, and iii) Current evidence/consensus gaps. By definition these categories are somewhat arbitrary and overlap.
It is hoped that this supplement will allow dissemination of the very enriching exchanges that occurred and will encourage further networks and multicenter research to effectively prevent the continuation of female genital mutilation/cutting (FGM/C), improve health and understand the needs of women and girls who live with FGM/C.
Advocates, researchers and healthcare professionals have sometimes devoted a life time to preventing the procedure and treating complications of FGM/C, in both high prevalence and diaspora countries. Building on this momentum and experience can further propel this field forward. Collaboration and sharing data, thoughts, experiences and controversies can improve our work and research in eliminating myths and misconceptions; understanding how the eradication of FGM/C can be accelerated and improving the care and communication with girls and women with FGM/C and their partners.
The ideas and conclusions reported in the abstracts presented in the supplement made by individual researchers and institutions are solely the responsibility of the authors and do not necessarily represent the views of the meeting’s organizers and their institutions.