Peer-reviewed article
Impact of female genital mutilation laws, policies, and professional codes of conduct on healthcare workers' knowledge, attitudes, skills, and quality of care: A mixed-method review.
Asaolu I, Oringanje C, Arikpo D, Aquaisua E, Ndukwu D et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined 12 qualitative studies on how laws, policies, and professional codes affect healthcare workers' responses to female genital mutilation (FGM). The review found that healthcare workers often lack knowledge of FGM laws, and legal prohibitions alone do not change their behavior or attitudes. Many providers continued to support or refer for FGM due to cultural beliefs, religious views, financial incentives, and weak law enforcement, while others avoided it due to legal risks. Providers also reported discomfort with mandatory reporting requirements and concerns about losing patient trust.
Key points
- Over 230 million girls and women have undergone FGM, but enforcement of prohibitive laws remains a challenge
- Healthcare workers often had limited knowledge of FGM laws, which impeded changes in their attitudes toward the practice
- Some providers continued supporting or referring for FGM because of cultural norms, religious beliefs, financial incentives, and weak enforcement
- Providers expressed discomfort with mandatory reporting and concerns about compromising patient trust
- Legal awareness alone does not change healthcare worker behavior; comprehensive training, ethical guidance, and stronger enforcement are needed
Limitations
This review included only qualitative studies (12 studies from 2010 records) and found no eligible quantitative studies, limiting evidence on measurable outcomes of laws and policies. The review does not provide evidence on the effectiveness of specific interventions or the impact on girls' and women's health outcomes.
Abstract
Background Over 230 million girls and women worldwide have undergone female genital mutilation (FGM), primarily in Africa, the Middle East, and parts of Asia. Although many countries have laws prohibiting FGM, enforcement remains a challenge. Efforts to eliminate FGM require a multifaceted approach, including policy implementation, community education, and training of healthcare workers (HCWs). Objectives To explore how laws, policies, and professional codes of conduct related to FGM prevention and care affect HCWs' knowledge, attitudes, skills, and care delivery. Search strategy A comprehensive search of the following electronic database was conducted: CINAHL Plus, IRIS, MEDLINE, PsycINFO, SCOPUS, and Web of Science. No language restrictions were applied in the literature search. Selection criteria Studies involving HCWs' perspectives or experiences with FGM laws and policies were included. Titles and abstracts were screened using Covidence, full texts were assessed for eligibility, and disagreements were resolved by a third reviewer. Data collection and analysis All included studies were assessed for quality using an adapted version of the Critical Appraisal Skills Programme (CASP) tool. A thematic synthesis of the qualitative data was conducted, involving coding of the extracted data and performing thematic analysis. Main results This review of 12 qualitative studies, from 2010 database records, identified six key themes regarding HCWs' experiences with FGM laws. HCWs often had limited knowledge of FGM laws, which impeded attitude changes toward FGM practices. Although some providers avoided performing medicalized FGM due to legal repercussions, others continued supporting or referring patients, because of cultural norms, religious beliefs, financial incentives, and weak enforcement. In addition, providers expressed discomfort with mandatory reporting and concerns about compromising patient trust. In some contexts, FGM laws were seen as contributing to health inequities by restricting culturally significant procedures while allowing similar or more invasive ones for others. The findings also revealed the emergence of modified FGM forms and significant gaps in providers' knowledge and communication skills when explaining legal prohibitions to affected girls and women. Conclusions This review found no eligible quantitative studies. Qualitative findings reveal legal awareness alone does not change behavior. Therefore, comprehensive training, guidance on professional ethics, and stronger enforcement are needed to support HCWs in FGM prevention and response.