De-colonising FGM a paper in BMJ

[Imnobody4]

Harms of the current global anti-FGM campaign

Abstract

Traditional female genital practices, though long-standing in many cultures, have become the focus of an expansive global campaign against ‘female genital mutilation’ (FGM). In this article, we critically examine the harms produced by the anti-FGM discourse and policies, despite their grounding in human rights and health advocacy. We argue that a ubiquitous ‘standard tale’ obscures the diversity of practices, meanings and experiences among those affected. This discourse, driven by a heavily racialised and ethnocentric framework, has led to unintended but serious consequences: the erosion of trust in healthcare settings, the silencing of dissenting or nuanced community voices, racial profiling and disproportionate legal surveillance of migrant families. Moreover, we highlight a troubling double standard that legitimises comparable genital surgeries in Western contexts while condemning similar procedures in others. We call for more balanced and evidence-based journalism, policy and public discourse—ones that account for cultural complexity and avoid the reductive and stigmatising force of the term ‘mutilation’. A re-evaluation of advocacy strategies is needed to ensure that they do not reproduce the very injustices they aim to challenge.

https://jme.bmj.com/content/early/2025/09/25/jme-2025-110961

Nope. I work at a very busy London Unit and we have never had an incident where we didnt know a woman had FGM until Labour. That would only happen if your antenatal care was substandard. You're not using the correct language and/or building enough of a rapport with women for them to trust you enough to disclose. Or you are only asking women who "look like they might be from an FGM country" rather than every single woman you encounter. These are examples of shoddy maternity care which fails to protect the most vulnerable. Nothing new but all the fault of the system and the staff within it.

This is why it is so important to learn to communicate with the person in front of you.

Hi!
I’m a long time lurker on this site and have never made an account, and I probably won’t use this account again.
I just wanted to add from my experience of FGM, girls are often taken to their home countries to be mutilated, this is typically before puberty as it’s easier to convince them, or rather brainwash them. These days, it’s more difficult to take a girl abroad as there is a lot more awareness, medical professionals are a lot more switched on with it, and I’ve heard of stories of girls being “checked” at UK airports.
Also, the women who are now 40+ have had the type 3..
Most FGM women in the 30’s have had type1/2. Thankfully with each generation the type is becoming less brutal!
In the community I’m from women in their 20’s haven’t had FGM. It’s because their mothers are typically raised here in the UK and are more educated.
There are so many girls that aren’t mentioned in the stats, as they have had type 1/2. It would go completely unnoticed.
Can I add, this isn’t every girl or woman and this is certain communities in the UK.
The statistics are ALOT higher in African countries. Thankfully in the UK it’s slowly on its way out!
sorry for the typos!

You’ve given me something to think about!

The below is very much me ‘typing out loud’. If I’ve missed anything, please let me know!

While ‘traditional’ FGM is appalling, both because even if done in sanitary conditions it is the forcible mutilation of a young girls sex organs both to deprive her of pleasure and ensure that she is ‘pure and modest’ for a man. How does that transfer to labioplasty in women?

While it is an ‘asthetic’ rather than a modesty/ purity thing, it is still society and culturally driven, with its roots almost certainly in pornography.

We don’t allow people to cut their legs off, we do allow people to have breast augmentations.

I think you can’t really compare FGM and labioplasty as the former causes measurable harm/reduction in function, the latter does not. The former is done to young girls/women by others, that latter is done by adult women to themselves.

While I don’t think labioplasty for none medical reasons are a good thing. I can’t help feeling that comparing the two is apples and oranges and done out of a primary fear that being against FGM is driven by racist ideas rather than the safeguarding of women.

In summary I think that the BMJ is more worried about being considered racist that protecting women/girls.

Really you cant though. Those surgeons are behaving illegally.

Well I haven’t either but I wouldn’t judge another HCP who had. How could antenatal care be substandard if they hadn’t had any? And I’m pretty sure every pregnant woman is asked the question, not just ones who “look like they’re from an fgm country “. Pretty sure NICE guidelines say ask everyone.

So why don't we offer relatively safe versions of FGM to private adult patients? It is infibulation that is a long term risk factor when it comes to FGM, but that is only usual in type 3 and sometimes type 2.

No, don’t apologise for the typos, that is fascinating!

Not being an expert on FGM or having any first hand experience, do you mind me asking whether you think the move away from type 3 to type 1/2 may have informed or allowed the BMJ to justify their position?

No a lot of midwives have admitted that they don't ask everyone the FGM question because they find it difficult to raise and offensive to ask and they believe it is irrelevant to some populations. You're far more likely to get to labour with labial rings we do not know about than FGM.

Labioplasty is very different to fgm though? Yes one’s legal and one isn’t. One is done by choice and the other usually isn’t. Labioplasty might be done for cosmetic purposes but also for more of a medical type purpose. One of my labia is bigger than the other and it’s uncomfortable at times. I don’t care what it looks like but I care what it feels like.

i won’t be having surgery but if I did that surgery wouldn’t prevent me from menstruating effectively or passing urine effectively this increasing my risk of infection. It wouldn’t have been done for the purpose of controlling me. It wouldn’t have been done to remove parts of my body which give me sexual pleasure thus preventing me from orgasming. It wouldn’t have been potentially life threatening.

Circumcision?

Has it become more prevalent or was it always there and we weren't aware of it because it wasn't widely spoken about. Now, because of the internet and increased immigration the practices, why's, who's and where's are in the public domain.

If you did have that surgery on the NHS, they'd remive tissue that was chaffed or inflamed but they wouldnt make the appearance equal as in remove healthy tissue from the other side to make your labia appear symmetrical/equal. That would breach FGM regulations. You'd have to have evidence of skin changes to support the idea that your labia is abnormal and problematic, too.

Hhhmmm, well if any midwife isn’t asking that’s bad. Hospitals should be regularly auditing notes and pulling any midwife up who hasn’t “ticked the box”. Where I work notes are audited and I’ve never come across a set where the box for asking hasn’t been ticked. Though I accept people could be lying and ticking the box without asking but I’d be amazed. I’ve also never heard of anyone at my unit get to Labour ward with unknown fgm but then I’ve also never known any woman at the hospital where I work have fgm. Not including piercings in that.

Yeah I don’t have skin changes as I have learnt to “tuck one in” quite well. Sometimes it needs a bit of rearranging. It’s irritating but i wouldn’t be asking for surgery.

Lol thank you! Trying to type whilst putting my baby to sleep.

Yes, I think so.
I think it’s dangerous to be so concerned with racial profiling that children are left unprotected. It’s child abuse.
It also shouldn’t be compared to surgeries, where a woman has fully consented and understands the risks and complications.
Children are totally manipulated.
When I was younger it was UNHEARD of to not have had FGM. However now, it’s very common to not be “cut”

I get it, I think. It's a bit like the sort of feminism that responds to "men are rational, women are merely emotional, therefore men are superior" with "women are intuitive, men are merely logical, therefore women are superior", instead of rejecting sexist stereotyping altogether.

It's reversed the good/bad values, but hung on to the same kind of race-stereotype-obsessed mindset that produced them in the first place, still seeing white people as an exception to the rule, whether different-better or different-worse.

We are losing sight of the OP here, which is that the BMJ - the BMJ - has published a paper which apparently argues that we should allow people from certain cultures to continue this mutilation of young girls.

No, no, no.

I find it absolutely crazy this was even published!

There are cosmetic procedures you can have done. Labia reduction, vaginal rejuvenation,

https://www.rightdecisions.scot.nhs.uk/maternity-gynaecology-guidelines/gynaecology/gynaecology-guidelines/guidelines-a-z-all-gynaecology-guidelines/female-genital-cosmetic-surgery-gynaecology-626/

Nope not at all.

I think there is an argument that social coercion of girls/young women druvrs both western cosmetic genital surgery and what westerners call eastern/southern genital mutilation.

It’s all mutilation imho- except for birth injury repair.

Please please please let’s not compare any of these surgeries to FGM. FGM isn’t a surgery. It’s not life saving, it’s unnecessary and damaging. It’s done without consent, and to little girls. It’s not for cosmetic reasons. Type 1 is to keep you a virgin until marriage.

Teenagers can get labioplasties.
https://academic.oup.com/asj/article/43/7/NP516/7071512?login=false
One of the side effects of cosmetic surgery is reduction or loss of sensation and pleasure. It doesn’t matter whether they are cut to make your vulva look prettier to meet some beauty standard or cut to meet a modesty standard, the biological impact is the same.

Why not? Have you even compared what is cut in both, side by side? Who is being cut and why? The impacts?

I agree there is a double standard and that FGM is slowly creeping into our culture and becoming whitewashed as acceptable because it’s for beauty not modesty.

Sorry what are you talking about?
I’m talking about a child being mutilated compared to a woman who has consented to plastic surgery. These two cannot be compared.