Female genital cutting/mutilation (FGC/M) is internationally recognized as a harmful practice that results in the violation of human rights.1 FGC/M refers to procedures that involve the infibulation, excision or mutilation, in whole or in part, of the labia majora, labia minora or clitoris.2
Performing, assisting in or referring patients for FGC/M procedures is illegal in Canada, as the Criminal Code identifies FGC/M as aggravated assault. It is also a criminal act to remove a child under the age of 18 from Canada to perform FGC/M on them.3 Performing or contemplating performing FGC/M on anyone under the age of 18 raises child protection concerns, and physicians have a legal obligation to notify child protection authorities if they have reasonable grounds to believe that any child under the age of 18 has undergone, or is at risk of undergoing, an FGC/M procedure, regardless of where the procedure has been or may be undertaken.4 Physicians who have reasonable grounds to believe that another physician is performing FGC/M procedures must also report this information to the College of Physicians and Surgeons of Ontario (CPSO).5
Many international, national, and regional bodies, including the Ontario Human Rights Commission, the World Medical Association and The Society of Obstetricians and Gynaecologists of Canada (SOGC), have released statements opposing the practice and participation of physicians in FGC/M.
CPSO strongly condemns the practice of FGC/M and recognizes it as a form of gender-based violence that violates physical integrity and psychological well-being. Physicians will be subject to disciplinary measures if they perform, assist in or refer patients for FGC/M procedures.6
Physicians play an important role in opposing and denouncing the practice of FGC/M. Physicians can support patients by educating themselves on how to properly manage possible complications related to FGC/M, and by providing culturally sensitive counseling to families about the dangers of the practice.
Physicians who encounter patients who have undergone FGC/M can obtain guidance from sources such as the SOGC’s comprehensive Clinical Practice Guideline (the Guideline).7 Among other things, the Guideline provides direction on legal issues related to the practice, as well as guidance for the management of obstetrical and gynaecological complications related to FGC/M. Physicians can also consult the interagency statement, Eliminating Female Genital Mutilation, to strengthen their knowledge and understanding of the practice of FGC/M.8
1. OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO. Eliminating female genital mutilation: an interagency statement. Geneva: WHO 2008: 22–7. Available at: https://apps.who.int/iris/bitstream/handle/10665/43839/9789241596442_eng.pdf?sequence=1 Accessed December 13, 2019 (hereinafter, Interagency Statement).
2. Except where performed for the benefit of the physical health of the person or for the purpose of the person having normal reproductive function, sexual appearance or function, or the person is at least 18 years of age and there is no resulting bodily harm. See s. 268(3) of the Criminal Code, R.S.C., 1985, c. C-46 (hereinafter, Criminal Code).
4. See s. 125(1) of the Child, Youth and Family Services Act, 2017, S.O. 2017, c. 14, Sched. 1 and s. 273.3(1) of the Criminal Code, as well as the College’s policy, Mandatory and Permissive Reporting.
5. See the Mandatory and Permissive Reporting policy.
6. Among other things, under to the Medicine Act, 1991, it is an act of professional misconduct for a physician to contravene a federal law (e.g., the Criminal Code) if the purpose of the law is to protect public health, or the contravention is relevant to the member’s suitability to practise medicine. Furthermore, according to s. 51(1)(a) of the Health Professions Procedural Code, which is Schedule 2 to the Regulated Health Professions Act, 1991, S.O. 1991, c.18, a panel shall find that a member has committed an act of professional misconduct if the member has been found guilty of an offence that is relevant to the member’s suitability to practice, such as the FGC/M-related provisions of the Criminal Code.
7. For more information, please see the SOGC’s Clinical Practice Guideline: Female Genital Cutting.