Table 5 Health professionals’ attitudes towards FGMC

 Ashimi et al. 2014 [21]

Nigeria

53 % - prevent promiscuity

4 % would support FGM/C

NR^a

28 % - preserve virginity

4 % would perform FGM/C

16 % - socio-cultural acceptance

4 % of respondents (all women) would allow daughters to undergo FGM/C

10 % - religious reasons

8 % - medically beneficial

 Kaplan et al. 2013 [22]

Gambia

54 % - mandatory religious practice

43 % - were supportive of the continuation of FGM/C practice

NR

48 % - cultural practice

47 % - intended to subject their daughters to FGM/C

14 % - preserve virginity

43 % - medicalising FGMC would make the practice safer

1 % - it does not violate human rights

73 % - Health care workers have a role in eliminating FGMC

55 % – FGM/C cannot be eliminated in The Gambia

78 % - men should be involved in the debate about FGM/C

13 % - girls that have not undergone FGM/C should be discriminated against

 Ali et al. 2012 [23]

Sudan

51.2 % - cultural

19 % - all forms of FGM/C are harmful

NR

26 % - religious

76 % - only some forms are harmful

23 % - economic

5 % - all forms are not harmful

 Dike et al. 2012 [24]

Nigeria

51 % - prevent promiscuity

100 % would NOT have their daughters undergo FGM/C

To stop FGM/C:

47 % - appearance of external genitalia

81 % - Public enlightenment needed

27 % - tradition

25 % - Counselling of parents

11 % - initiation into womanhood

7 % - punishing any person who aids or abets the practice

7 % - spiritual satisfaction

 Rasheed et al. 2011 [25]

Egypt

100 % - senior physicians believed FGM/C prescribed by religion

Nurses:

NR

97 % - young physicians believed FGM/C prescribed by religion

88 % - supported the practice of FGM/C

88 % - nurses believe it is a traditional practice

48 % - would have their daughters undergo FGM/C

28 % - had their daughters undergo FGM/C

Young Physicians:

34 % - supported the practice of FGM/C

Senior physicians:

15 % - supported the practice

 Refaat 2009 [26]

Egypt

82 % - do NOT approve of the practice

18 % - supported practice; reasons for continuing practice included:

91 % - FGM/C and complications should be taught at medical school

Those practising in the Upper Egypt area, those from rural areas and those with a diploma (rather than PhD or Fellowship) were more likely to approve the practice of FGM/C

• Convinced of benefit

40 % believed that physicians are the most appropriate to perform FGM/C

• Profit

35 % did NOT approve of the law banning FGM/C

• Harm reduction

82 % - did NOT approve of the practice for the following reasons:

18 % - supported practice for religious or customary reasons

75 % - reduced sexual pleasure

64 % – pain

61 % - bad habit

52 % - not religious practice

49 % - causes health problems

48 % - against women’s dignity

 Mostafa et al. 2006 [27]

Egypt

51 % - NO medical reason for performing FGM/C

43 % - unethical for a health professional to damage a healthy body

50 % - medicalization is the first step to prevention of the practice

45 % - FGM/C is a violation of human rights

65 % - FGM/C is NOT a health issue

23 % - believed that the law is enough for prevention

34 % - FGM/C is essential part of culture

32 % - would subject their future daughters to this practice

53 % - believe that laws must go hand in hand with community education

24 % - FGM/C prevents external genitalia from growing

58 % - would NOT object if family members were to subject their daughters to FGM/C

20 % FGM/C ensures a girl’s virginity

73 % - FGM/C should be medicalised

49 % - prevents promiscuity

91 % - medicalization favourable because it reduces pain; carried out under hygienic conditions and with anaesthetic

30 % - FGM/C is a religious obligation

86 % - believed that FGMC is practiced only by Muslims

 Onuh et al. 2006 [28]

Nigeria

9 % - decreases promiscuity

4 % - will have their own daughters undergo FGMC

92 % - FGM/C should be legislated against

10 % - makes genitalia more attractive

3 % - FGM/C is a good practice

Other reasons: − cultural; financial; patient safeguarding from “traditional circumcisers”

3 % - will encourage FGM/C

24 % - some forms of FGM/C are not harmful

 Purchase et al. 2013 [30]

UK

76 % - cultural reasons

NR

NR

16 % - religious reasons

 Relph et al. 2013 [31]

UK

100 % - cultural reasons

9 % - FGM/C should be medicalized to reduce complications

87 % - would warn social services of a child in danger of FGM/C

18 % - would support a woman’s request for re-infibulation after birth if this was legal in the UK

 Moeed et al. 2012 [20]

Australia and New Zealand

NR

21 % - O&G specialists believed that in the women and girls with FGMC seen by them, the FGM/C was probably done in Australia (but they did not provide number estimates)

NR

42 % of the FGM/C workers believed that the women and children with FGMC probably had the procedure performed in Australia/NZ

26 % of FGMC/C workers believed that children were being taken out of Australia to attend family celebrations and to have FGM/C done overseas

 Kaplan-Marcusan et al. 2009 [33]

Spain

50 % - traditional reasons

NR

2001 -1 % said ignore the problem

16 % - religious reasons

48 % - educate

32 % - educate and report

19 % - report to authorities

2004 – None said ignore

49 % - educate and report

27 % - educate

24 % - report to authorities

 Leye 2008 [34]

Belgium

NR

86 % - FGM/C is a form of violence against women

21 % - believed that FGM/C performed by a medical practitioner would reduce harm

61 % - FGM/C is a violation of human rights

48 % - wanted more clarity around ethico-legal issues

7 % - FGM/C should be respected because of cultural and religious beliefs

77 % - considered re-infubulation as a form of FGM/C

19 % - would re-infibulate if requested by the woman

47 % - a symbolic incision was a good alternative to FGM/C

15 % - Genital piercings and vaginal cosmetic surgery considered a type of FGM/C