Guideline No. 395-Female Genital Cutting

Abstract Objectives To decrease the likelihood that the practice of female genital cutting (FGC) be continued in the future and to improve the care of girls and women who have been subjected to FGC or who are at risk by providing (1) information intended to strengthen knowledge and understanding of the practice, (2) information regarding the legal issues related to the practice, (3) guidance for the management of its obstetrical and gynaecological complications, and (4) guidance on the provision of culturally competent care to girls and women affected by FGC. Options Strategies for the primary, secondary, and tertiary prevention of FGC and its complications. Outcomes The short- and long-term consequences of FGC. Intended Users Health care providers delivering obstetrical and gynaecological care. Target Population Women from countries where FGC is commonly practised and Canadian girls and women from groups who may practise FGC for cultural or religious reasons. Evidence Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library in September 2010 using appropriate controlled vocabulary (e.g., Circumcision, Female) and key words (e.g., female genital mutilation, clitoridectomy, infibulation). Searches were updated and incorporated in the guideline revision December 2018. Validation Methods The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Benefits, Harms, and Costs There are no anticipated harms or costs to health care facilities with implementation of this guideline. Benefits may include a greater willingness of women living with FGC to seek timely care. SUMMARY STATEMENTS 1Female genital cutting is internationally recognized as a harmful practice and a violation of girls' and women's rights to life, physical integrity, and health (II-3). 2The immediate and long-term health risks and complications of female genital cutting can be serious and life-threatening (II-3). 3Female genital cutting continues to be practised in many countries, particularly in sub-Saharan Africa, Egypt, and Sudan (II-3). 4Global migration patterns have brought female genital cutting to Europe, Australia, New Zealand, and North America, including Canada (II-3). 5Performing or assisting in female genital cutting is a criminal offense in Canada (III). 6Reporting to appropriate child welfare protection services is mandatory when a child has recently been subjected to female genital cutting or is at risk of being subjected to the procedure (III). 7There is concern that female genital cutting continues to be perpetuated in receiving countries, mainly through the act of re-infibulation (III). 8There is a perception that the care of women with female genital cutting is not optimal in receiving countries (III). 9Female genital cutting is not considered an indication for cesarean section (III). RECOMMENDATIONS 1Health care providers must be careful not to stigmatize women who have undergone female genital cutting (III-A). 2Requests for re-infibulation should be declined (III-B). 3Health care providers should strengthen their understanding and knowledge of female genital cutting and develop greater skills for the management of its complications and the provision of culturally competent care to girls and women who have undergone genital cutting (III-A). 4Health care providers should use their knowledge and influence to educate and counsel families against having female genital cutting performed on their daughters and other family members (III-A). 5Health care providers should advocate for the availability of and access to appropriate support and counselling services (III-A). 6Health care providers should lend their voices to community-based initiatives seeking to promote the elimination of female genital cutting (III-A). 7Health care providers should use interactions with patients as opportunities to educate women and their families about female genital cutting and other aspects of women's health and reproductive rights (III-A). 8Research into female genital cutting should be undertaken to explore women's perceptions and experiences of accessing sexual and reproductive health care in Canada (III-A). The perspectives, knowledge, and clinical practice of health care providers with respect to female genital cutting should also be studied (III-A). 9Information and guidance on female genital cutting should be integrated into the curricula for nursing students, medical students, residents, midwifery students, and students of other health care professions (III-A). 10Key practices in providing optimal care to women with female genital cutting include: adetermining how the woman refers to the practice of female genital cutting and using this terminology throughout care (III-C). bdetermining the female genital cutting status of the woman and clearly documenting this information in her medical record (III-C). censuring the availability of a well-trained, trusted, and neutral interpreter who can ensure confidentiality and who will not exert undue influence on the patient-physician interaction when providing care to a woman who faces language challenges (III-C). densuring the proper documentation of the woman's medical history in her record to minimize the need for repeated medical histories and/or examinations and to facilitate the sharing of information (III-C). eproviding the woman with appropriate and well-timed information, including information about her reproductive system and her sexual and reproductive health (III-C). fensuring the woman's privacy and confidentiality by limiting attendants in the room to those who are part of the health care team (III-C). gproviding woman-centred care focused on ensuring that the woman's views and wishes are solicited and respected, including a discussion of why some requests cannot be granted for legal or ethical reasons (III-C). hhelping the woman to understand and navigate the health system, including access to preventive care practices (III-C) iusing prenatal visits to prepare the woman and her family for delivery (III-C). jwhen referring, ensuring that the services and/or practitioners who receive the referral can provide culturally competent and sensitive care, paying special attention to concerns related to confidentiality and privacy (III-C).