Report, by women surveyed, of type of practitioner who performed the FGM procedure.  Data should be disaggregated by women’s age, region, ethnicity and religion. It is important to use locally adapted wording to identify traditional practitioners.

Data Source(s):

A population-based survey, such as the Demographic and Health Surveys (DHS)

Purpose:

This indicator is intended to measure and monitor the prevalence of FGM as performed by various types of practitioners within a given population. It aims to:

1. Assess the role of medicalization in FGM practices, where medical professionals are involved.
2. Understand cultural and social dynamics by identifying traditional practitioners of FGM.
3. Inform public health interventions and policies that aim to eradicate FGM.
4. Provide data to help advocate for change within communities and health systems.
5. Track progress over time towards reducing and eventually eliminating the practice of FGM.

Many negative effects can follow an FGM procedure. Some of these effects depend on how the procedure itself was performed. For example, the chance of infection would be greatly reduced if performed within a clinical environment. Pain during the procedure would also be reduced if anesthesia were used within this environment. However, having the procedure performed by a health professional does not guarantee the procedure will be less severe or in sanitary conditions. Furthermore, it may do little to ameliorate the psychological effects of FGM, which have been widely reported in the literature. Since FGM is located within the social context of patriarchal social control over women and their sexuality, having the procedure done by a health professional represents progress in the wrong direction. Rather than working towards eliminating the practice, moving it within the clinical context lends credibility to the practice. It wrongly legitimizes it as being medically sound or beneficial for girls and women’s health. It can further institutionalize FGM as medical personnel often hold power, authority, and respect in society (WHO et al., 2008).

Having a trained health provider perform the procedure is inconsequential to the fact that FGM performed under any circumstances violates girls’ and women’s right to life, right to physical integrity, and right to health. Furthermore, it violates the fundamental medical ethic to ‘Do no harm’.  Thus, medical licensing authorities and professional associations have joined the UN organizations in condemning actions to medicalize FGM. The International Federation of Gynecology and Obstetrics (FIGO) passed a resolution in 1994 at its General Assembly opposing the performance of FGM by obstetricians and gynecologists, including a recommendation to “oppose any attempt to medicalize the procedure or to allow its performance, under any circumstances, in health establishments or by health professionals” (WHO et al., 2008).

Issues:

Issues with this indicator include underreporting, which is a significant concern since individuals might be hesitant to admit they have undergone FGM, especially if done by non-medical personnel. The variability in definitions of practitioners across different cultures can affect the consistency and comparability of data. Social desirability bias is also a problem, as women might claim a medical professional performed the procedure to avoid stigma. Data quality depends heavily on the memory and honesty of respondents regarding a potentially traumatic experience. Ethical issues arise when probing into such personal and sensitive topics, necessitating careful and sensitive data collection approaches. An additional consideration for this indicator is that if women were very young when they had the cutting performed, they may not remember or know who did it or what their qualifications were. One alternative would be asking women whether the procedure was performed in a health facility. An additional issue with this indicator is that if it is measured among women aged 15-49, age disaggregation may be needed to pick up changes in performer type over time. However, it will miss any current or recent provider-type changes occurring for girls aged 0-14.

Bloom S.  “Violence Against Women and Girls: A Compendium of Monitoring and Evaluation Indicators.”  USAID, IGWG, and MEASURE Evaluation, 2008.

Eliminating female genital mutilation: an interagency statement. UNAIDS,
UNDP, UNECA, UNESCO, UNFPA, UNHCHR, UNHCR, UNICEF, UNIFEM, WHO, 2008.

UNFPA Population Data Portal. (n.d.). Population Data Portal. https://pdp.unfpa.org/

Measuring effectiveness of female genital mutilation elimination: A compendium of Indicators. Prepared and published by UNFPA and UNICEF on behalf of the UNFPA-UNICEF Joint Programme on the elimination of female genital mutilation: Accelerating Change, 2020.