A/HRC/44/33 where it might be the only income for doctors, and indicated that a possible way to address the issue would be to include female genital mutilation in poverty reduction strategies and plans. 27. With respect to the prevention of the medicalization of female genital mutilation, the common responsibility of Governments, policymakers, medical professionals, lawyers and religious leaders at all levels was emphasized. It was also mentioned that WHO, in collaboration with key stakeholders, had developed a global strategy to stop female genital mutilation, which included a component to strengthen the understanding and knowledge of health-care providers as they were key agents of change in preventing the practice. WHO was currently supporting countries to develop and implement national health sector strategies. In the Sudan, the Ministry of Health had taken the lead since 2015 to operationalize the national strategy. Eight other countries were in different phases in terms of operationalization of the strategy.12 Participants welcomed the strategy and stressed the need to learn from the processes and evaluate its impact on medicalized female genital mutilation. 28. The discussions also touched upon whether adult women could consent to female genital mutilation in medical settings and, if so, how to support medical practitioners in assessing their full, free and informed consent. Some experts felt that the practice should never be allowed, even when requested by adult women, given the social pressure to which they might have been exposed that could vitiate consent. Other experts, however, warned about double standards when other medically unnecessary, potentially harmful surgical interventions on female genitalia, such as female medical cosmetic surgery, were allowed and reasons to perform them might also be attributed to social pressure. While the meeting did not come to a conclusion on the most desirable approach, experts agreed on the need for further discussions on how women’s choice and consent was understood in the context of patriarchal societies. V. Innovative approaches at the community level in scaling up interventions to address social norms and strengthen social accountability and data collection 29. Throughout the expert meeting, the notion of accountability for female genital mutilation was discussed. Human rights accountability meant more than ensuring criminal liability. It encompassed a broad range of other measures that States should take to ensure the full realization of the human rights of women and girls, inter alia through comprehensive and rights-based legislation and policies that were well resourced and the establishment of monitoring mechanisms. 30. In that context, the concept of social accountability was recognized as a useful and complementary framework as it relied on the engagement of members of the community and/or civil society organizations who participated directly or indirectly in demanding accountability from duty bearers. It referred to the broad range of actions and mechanisms that could be initiated and supported by the State, citizens or both, but were very often demand-driven and operated from the bottom up. They were meant to hold public officials accountable through, for example, public expenditure tracking tools, participatory budgeting, community scorecards to assess the satisfaction of service users and providers of services. 13 Mechanisms of social accountability entailed the participation of citizens and community groups in project planning, budgeting and monitoring. 31. In particular, the participants discussed how social accountability initiatives on female genital mutilation might benefit from the use of technology to gain access to information; monitor the implementation of legislation and policies; scale up budget 12 13 8 Those countries are Burkina Faso, Egypt, Ethiopia, Gambia, Guinea, Kenya, Nigeria and Somalia. Yemen was originally targeted as the tenth country to operationalize the WHO global strategy, but the work has not yet been initiated because of the conflict situation. See Carmen Malena, Reiner Forster and Janmejay Singh, “Social accountability: an introduction to the concept and emerging practice”, World Bank social development papers No. 76, (December 2004), p. 3.