A/HRC/44/33 States, the international community and the United Nations system to stop the medicalization of female genital mutilation. 23. Against that background, participants in the expert meeting discussed some of the arguments made in support of the medicalization of female genital mutilation, including that it reduced harm for women and girls and that it was a first step towards the elimination of the practice. According to WHO, health-care providers performing medicalized genital mutilation are in violation of the fundamental medical ethical principle of non-maleficence (“do no harm”) and the fundamental principle of providing the highest quality health care possible.9 Experts noted that in the absence of evidence, it was unclear how medicalization reduced harm and health risks for women and girls. By contrast, there were documented long-term complications associated with female genital mutilation, particularly regarding sexual and reproductive rights and psychological and obstetric complications. Several experts also stressed that instead of contributing to its elimination, medicalization could contribute to the normalization or institutionalization of the practice, rendering it a routine procedure and perhaps even encouraging it. Others referred to the trauma that undergoing female genital mutilation entailed for girls, irrespective of who performed it, and how that trauma might affect their future relationships, including with medical practitioners. 24. Based on existing experience, the experts discussed a number of promising practices to better address the trend towards the medicalization of female genital mutilation. In the context of Burkina Faso, for example, it seemed that a strong legal framework with large penalties for medical practitioners had been effective in reducing medicalization, as fear of incurring a prison term or losing the licence to practice had acted as a deterrent. For its part, the Sudan had developed in 2016 an accountability framework for midwives to ensure the quality of services provision and to address medicalized female genital mutilation. The adoption of a medical code and the integration of female genital mutilation issues in the curricula of medical schools as well as in pre- and in-service training for medical professionals and midwives was mentioned as necessary for building the capacities of the medical sector. Rights-based training material for medical doctors and midwives by United Nations agencies, in particular WHO, were mentioned as critical to building awareness of the unacceptability of female genital mutilation. The need for guidelines for medical practitioners on how to respond to the pressure to which they might be subjected to perform medicalized female genital mutilation and equip them with key messages for communities on reasons to abandon the practice was also stressed. 25. Other experiences shared included the work currently undertaken with the media and communities by health-care professionals, including “Doctors against Female Genital Mutilation” in Egypt, to raise awareness of the issue and with students in medical schools to mobilize them against the practice. Similarly, the lead role of professional medical associations in condemning actions to medicalize female genital mutilation was mentioned as an important contribution to reducing the prevalence of the practice. For instance, the Arab syndicates of doctors from Egypt, Somalia, the Sudan and Yemen and midwives from Djibouti and the Sudan had adopted public statements in 2017, in which they recognized the practice as a violation of the rights of women and girls and further committed to take action to eliminate the practice. At the national level, similar public statements had been made by different professional associations (nurses, midwives practitioners of obstetrics and gynaecology and paediatric associations) during their annual professional meetings, for example in the Sudan since 2016. 26. Research has shown that the medicalization of female genital mutilation may lead to some health-care providers developing a financial interest in upholding the practice, although it is not always the primary motivating factor. 10 Material gains are mostly in the form of money, but also in the form of gifts. 11 In that respect, experts acknowledged the challenges associated with addressing the issue of economic gain, especially in contexts 9 10 11 WHO, Care of Girls and Women Living with Female Genital Mutilation: a Clinical Handbook, p. 392. See Samuel Kimani and Bettina Shell-Duncan, “Medicalized female genital mutilation/cutting: contentious practices and persistent debates”, Current Sexual Health Reports, vol. 10, No. 1 (February 2018). See Marie-Hélène Doucet, Christina Pallitto and Danielle Groleau, “Understanding the motivations of health-care providers in performing female genital mutilation: an integrative review of the literature”, Reproductive Health, vol. 14 (March 2017). 7