Female genital mutilation (FGM) includes 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. UNICEF estimates that more than 230 million girls and women alive today have undergone FGM, in more than 30 countries across Africa, the Middle East and Asia, and in diaspora communities worldwide. WHO recognises FGM as a violation of the human rights of girls and women. Nurses and midwives care for women living with FGM and have a role in protecting girls at risk.
Types (WHO classification)
- Type 1: partial or total removal of the clitoral glans and/or prepuce.
- Type 2: partial or total removal of the clitoral glans and labia minora, with or without removal of the labia majora.
- Type 3 (infibulation): narrowing of the vaginal opening by creating a covering seal.
- Type 4: all other harmful procedures (pricking, piercing, cutting, scraping, cauterising).
Health consequences
- Immediate: severe pain, bleeding, shock, infection (including tetanus), urinary retention, death.
- Long-term: chronic pain, recurrent urinary and vaginal infections, menstrual problems, cysts, painful sex, infertility.
- Childbirth: increased risk of prolonged labour, tears, haemorrhage and newborn complications; Type 3 may need deinfibulation.
- Psychological: anxiety, depression, post-traumatic stress.
Sensitive communication
- Use the woman’s own terms (she may say “cut”, “circumcision”, “sunna”).
- Avoid shock or judgement in your expression and words.
- Use a professional female interpreter if needed, never a family member. See working with interpreters.
- Ask about symptoms and how it affects her life.
- Offer referral to specialist services, including deinfibulation and psychological support.
In pregnancy and childbirth
- Ask about FGM at booking in a sensitive, routine way.
- Plan care: deinfibulation may be offered antenatally (often second trimester) or during labour.
- Re-infibulation after birth is prohibited in many countries and goes against WHO guidance.
- Discuss the risk to daughters and the law.
Safeguarding girls at risk
Indicators that a girl may be at risk include a mother or sisters who have had FGM, family from a practising community, plans for an extended trip to the family’s country of origin, or a girl talking about a “special ceremony”. Follow safeguarding procedures. In some countries, such as England and Wales, regulated health professionals have a mandatory duty to report to the police known cases of FGM in girls under 18. See our safeguarding guide.
The law and the “medicalisation” problem
FGM is illegal in many countries, including Nigeria (under the Violence Against Persons (Prohibition) Act 2015), Kenya, Ghana, the UK, the US and many others. WHO is concerned that a growing share of FGM is performed by health workers (“medicalisation”), which does not make it safe and legitimises the practice. Nurses and midwives must never perform FGM, regardless of requests from families.
Changing norms
Many communities are abandoning FGM. Nurses can support this by sharing accurate health information, working with community and religious leaders, and amplifying the voices of survivors.
Based on WHO FGM fact sheet and guidelines on management of health complications from FGM, UNICEF data, and UK Government multi-agency statutory guidance on FGM. Educational content.