Lifting the veil on genital mutilation

3 minute read

A new survey sheds some light on a practice which is shrouded by stigma and silence


There is an increasing need for awareness of the issues surrounding female genital mutilation with a survey of paediatricians revealing the illegal procedure is being performed on children living in Australia.

The survey, which is the first of its kind in Australia, found that 10% of paediatricians and clinicians had seen cases of genital mutilation in females under the age of 18 during their career.

Out of the 1,003 clinicians surveyed, 2.3% reported seeing mutilation in girls in the past five years.

The WHO defines the practice as “all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons”.

The procedure is typically undertaken on newborns and girls up to the age of nine, but can often be performed on older girls and young women.

There was a high awareness among paediatricians of the complications that could arise from different types of female genital mutilation, which (in the survey) included urinary dysfunction, chronic pain and gynecological, obstetric and psychological problems.

“This procedure is illegal in Australia,” lead author Elizabeth Elliott, a Professor of Paediatrics and Child Health at the University of Sydney, said. “This [result] surprised us. It was perhaps higher than we would have expected.”

Female genital mutilation, which affects 200 million girls and women, is internationally recognised as a violation of human rights.

Performing or procuring the procedures carries a prison sentence of up to 21 years across all states and territories, regardless of whether the procedure is done in Australia
or overseas.

Despite this, paediatrician respondents observed a total of 59 instances of the practice between 2009 and 2014.

The majority of these children were refugees born in African countries, including Kenya, Sudan, Eritrea, Ethiopia, Sierra Leone, Somalia and East Africa.

Only three instances involved children who were born in Australia, with two having the procedure done locally and one in Indonesia.

“The most important message from this paper is that GPs may see genital mutilation in girls who are living in Australia,” said Professor Elliott.

“What GPs really need to know is which groups are most at risk and what their obligations are with regard to management of these girls.”

GPs are required to report instances where children are at risk, or have undergone, these procedures to child protection authorities.

But the survey found only one-fifth of cases were reported to authorities, reflecting a possible lack of awareness of the mandatory reporting obligations, the authors wrote.

In addition, many of the specialists surveyed were not aware the practice was also prevalent in central and south-east Asia.

Up to half of the female population undergo a version of the procedure in Indonesia, while up to 70% of women are affected in some African countries, WHO and Indonesia Population Council data shows.

“If (clinicians) see a girl in an at-risk population they should at least ask the mother if she has the procedure done, because that’s one of the biggest risk factors,” Professor Elliott said.

BMJ 2017, online 12 January

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