Female genital mutilation/cutting (FGM/C) comprises all procedures that involve partial or complete removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons (WHO 2016). FGM/C is classified into four types (I, II, III, IV) that vary by the anatomical extent of cutting and amount of genital tissue removed. FGM/C has no health benefits but, instead, leads to a myriad of life-threatening and life-worsening complications. The practice is recognised internationally as a violation of the rights of women and girls and reflects ingrained gender inequality. It is estimated that more than 200 million girls and women alive today have undergone FGM/C in 30 countries in Africa, Asia, and the Middle East, where FGM/C is mostly found (UNICEF 2016). Two-thirds of all girls who have undergone FGM/C are from four countries: Egypt, Ethiopia, Nigeria, and Sudan (Shell-Duncan, Naik, Feldman-Jacobs 2015). FGM/C is widespread in Nigeria. According to the 2013 Nigeria Demographic and Health Survey (NDHS), overall FGM/C prevalence in Nigeria is 25 percent among women ages 15 to 49 years old (NPC and ICF 2014). Over half (62%) of cut women reported FGM/C types I or II. Despite the local and international call to abandon the practice, there is evidence that some Nigerian families, instead of abandoning the practice outright, are opting for medicalised forms. Medicalisation of FGM/C involves the use of health care providers—doctors, nurses/midwives, or other health professionals— to perform the practice either at facilities or at home; it also includes the procedure of reinfibulation at any point in a woman’s life (WHO 2010). Although medicalisation is presumed to reduce the risk of complications, it does not eliminate them and does not alter the fact that FGM/C is a violation of women’s and girls’ rights to life, health, and bodily integrity. Medicalisation accounts for 12.7 percent of FGM/C practice in Nigeria (NPC and ICF 2014). There is minimal information on medicalisation in Nigeria beyond the prevalence rates available in the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS). Additionally, there is limited understanding of how medicalisation has evolved or is evolving in Nigeria especially as it relates to the prospect of abandonment. The context of decision-making and rationale around medicalisation for families and health workers and the effect of medicalisation on the severity of cutting is also poorly understood. This community-based, cross-sectional qualitative study, which was conducted in four communities in Nigeria’s Delta, Ekiti, Imo, and Kaduna states, was conceptualized to address these gaps in our understanding of medicalisation and to provide critical evidence needed to effectively design abandonment interventions. These states were selected because of their relatively high prevalence of FGM/C and medicalisation of FGM/C, according to data from the Nigeria DHS 2013 (NPC and ICF 2014). These states are also located in the four geopolitical zones (South West—Ekiti; South East—Imo; South South—Delta; North West—Kaduna) of Nigeria, with the highest prevalence of FGM/C practice. In-depth interviews (IDIs) were conducted with parents of girls who had undergone FGM/C by traditional cutters and health workers and health workers who perform, or have performed, FGM/C. The study findings reveal that the social norms driving FGM/C practice remain entrenched despite a shift to medicalisation. They also reflect the tendency of parents and health workers to view FGM/C, whether traditional or medicalised, as a minor procedure with few complications and significant benefits that would positively impact a daughter’s future status as a wife and mother. Minimal public discussion of FGM/C, early age at cutting, the type of FGM/C practiced (Type I, clitoridectomy), limited knowledge of the extent of the procedure and its complications likely contribute to this perception of FGM/C as a benign and valuable practice. With respect to decisionmaking, parents made FGM/C decisions, with the male household head having the final say despite being removed from the mechanics and healing process.
