What follows is my initial response, via the journal Gynaecology, to a recently published academic paper which many see as a backlash to women’s rights and entitlements. In September 2025 the Journal of Medical Ethics (JME), part of the British Medical Journal (BMJ) group, published an extended, multi-authored, essay entitled ‘Harms of the current global anti-FGM campaign‘. Initially unremarked, in December the essay began to be circulated everywhere, causing confusion and alarm in many quarters: people active in the #EndFGM field asked, how can this be serious?  How can it have been published by the BMJ/JME? Gynaecology asked me for an Opinion piece…

You can read this website in the language of your choice via Google Translate.

The JME extended essay has now been very widely read (having 25 multinational authors helps…) and is long – verging on seven thousand words – but my Opinion piece here does not attempt to address all the matters arising from it, however sophistic some of the commentary may be.

Rather, I have focussed on the elemental message: that it is apparently acceptable to criticise flatly the language and action frameworks of eradicating FGM, thereby denying that this is a fundamentally dangerous and harmful practice; it is okay to critique bluntly the perceptions of those at the sharp end of trying to eradicate female genital mutilation.  It is even, apparently, acceptable to assert that patriarchy is an irrelevance to FGM and other similar matters.

My Opinion piece in Gynaecology is available here: Are ‘Anti-FGM’ Campaigns Harmful?  A hyper-linked version of it is below.

Had these extended essay writers produced a paper which suggested, respectfully, that commentators, survivors and activists (often themselves traumatised by what they have experienced and/or seen) might consider various wider aspects of approaches to #EndFGM in order more effectively to get the message about harms across, that might have been useful.  Many would I think be interested in suggested ways forward to eradication.

To claim however that FGM can be an actual positive in a woman’s or girl’s life is beyond the pale.  It is a denial of the rights to personal and bodily autonomy of women who are not in a position to defend themselves; it is also a serious refutation of legal and medical positions in almost every country in the world; and it facilitates the ‘anti-women’ backlash that many of us now see developing across the globe.

OPINION: Are ‘Anti-FGM Campaigns Harmful?

The conflicting tensions between tradition and contemporary thought produce many constructive debates; but not all such ‘tensions’ justify even-handed discourse.

One such topic which lies beyond debate, at least around its justification or otherwise, is female genital mutilation (FGM) – also known by some as ‘female genital cutting’, although that is an inaccurate overall description of the various harms the act entails.

The Journal of Medical Ethics (JME), which is published by the British Medical Journal in association with the Institute of Medical Ethics, in September 2025 published an extended essay entitled ‘Harms of the current global anti-FGM campaign’ on this matter. In their paper however the authors have chosen to refer to ‘female genital practices’, apparently because they regard this as a less prejudicial (?) nomenclature (Might ‘female genital incursions’ have been a more adept term?).

Whatever, this topic is too important for many of us working in the ‘anti-FGM’ field to tolerate in an even-handed, ‘some good, some bad’, sort of way. Every year around three million girls (including also some women) are ‘cut’, and the number of women and girls alive today with FGM is approximately 230 million. Inevitably, huge numbers of these women and girls will have experienced harm to their health and/or well-being.

The point of the JME paper is however, to make a case, particularly to ‘journalists and policy makers’, for more insight into, or at least understanding of, the wide variety of modes of FGM and the benefits its perpetrators (and some terminologies) suggest or believe it may also confer.

The claim is that “female-only, primarily African practices [are] treated categorically differently from all comparable practices, whether on children or adults in the Global North or South, … based in large part on misleading, often racialised, stereotypes, unrepresentative extreme examples, Western sensationalism and cultural exceptionalism, exaggerations of risk, and not a small amount of misinformation”.

These are remarkable claims which have already since publication been contested by many, not least by authors such as Janice Turner and Jawad Iqbal in the media, but further consideration may still be helpful.

Medical issues

Leaving aside the fundamental question for legal specialists of whether advocating for FGM comprises a call to break the law of many countries, of this paper’s twenty five cited authors, only one or two appear to be actual medical doctors, which may explain why the mortality routinely associated with FGM receives scant focus. This is a serious matter, given that one recent (2023) study by researchers at the University of Birmingham suggests that “… a 50% increase in the number of girls subject to FGM increases their 5-year mortality rate by 0.075 percentage point (95% CI -). This increased mortality rate translates into an estimated 44,320 excess deaths per year across countries where FGM is practised. These estimates imply that FGM is a leading cause of the death of girls and young women in those countries where it is practised accounting for more deaths than any cause other than Enteric Infections, Respiratory Infections, or Malaria”.

Tens of thousands of annual deaths of children might be thought significant, but the authors of the JME ethics paper apparently dismiss morbidity and mortality estimates as generally unreliable or exaggerated. At what level might the statistics be acceptable, one wonders?

And at what level, similarly, might morbidity harms attributed to FGM be significant, given that the authors of the JME paper regard them as to an extent unproven? (Is there any evidence that FGM may give rise, for instance, to child stunting? Do we know?) How much evidence of ill-health in women and their babies do we need before we must act definitively against FGM?

Educational and economic issues

The apparent dearth of expertise in economics or education amongst the JME paper authors may likewise account for the omission of discussion around the increased likelihood that girls undergoing FGM will shortly thereafter enter early/child/forced ‘marriage’ (CEFM – sometimes under-age legalised rape), at the same time losing access to education and the opportunities it would open up for them. (NB Education – especially internet literacy? – may now be as necessary, say, for many women in agrarian communities, trying to tackle climate change and other challenges, as it is for nurses, teachers and lawyers who sometimes move on to more urban locations).

The point about education and economic standing is that these are aspects of autonomy and power in an increasingly interconnected world. They are not only about the rights of the individual being, in the JME writers’ judgement, Global-North-style ‘paramount over the community’… though we might also enquire why elders in a community anywhere have legitimate authority to subject minors to processes which will harm their health forever; just as we might also ask why these elders sometimes do not insist on adequate water and other resources to serve their women – the main collectors of water – and thereby their whole community, better.

It is not Western imperialism to think likewise that more skill in managing one’s environment – the source of sustenance and maybe good fortune – is required only for the ambitious ‘modern’ woman in the Global North, when a UK report on Economic empowerment for adolescent girls considers the evidence around FGM and other traditional constraints, and shows these factors to be an important impediment to young women’s capacity to navigate their lives even in modern urban societies. Education matters everywhere.

The JME authors refer to the community inclusion and benefits which FGM may confer, especially in traditional locations (presumably both African/South Asian and in diaspora settings), but there is no acknowledgement that this inclusion may also result at a very early age in solid – and unknowing – exclusion, via imposed marriage, ill-health, long-established edicts and so on, from any other options.

Other critiques

And so we move to more particular critiques by the JME authors of the narrative on FGM.

Only a few can be considered here – psychology, law, clinical practice and professional regulation will also doubtless be the subject of vigorous debate. But for instance the authors’ claim that in the Global North female genital cosmetic surgery (FGCS) is uncontroversial and openly available to young girls as well as adult women – there is in fact an active debate on these FGCS issues and the related question of ‘intersex’ surgery – and, at least as importantly, that male genital mutilation (‘circumcision’) and ‘trans’ surgery remain universally unchallenged, cannot be ignored.

Again, these assertions are simply not true; indeed, there are many who would welcome more debate about male circumcision, FGCS or trans surgery (especially for minors). There is a case to answer on these matters, but they are by no means invisible issues. The JME authors allude to a ‘process of silencing’ on such themes. Perhaps these writers could help by engaging constructively in the significant debates already in process, and by showing their respectful acknowledgement of the many survivor-campaigners who have very different perspectives?

Patriarchy

One further, massive issue does however require examination: patriarchy. Patriarchy is ubiquitous, not least in its patriarchy incarnate form, applied to all types of ‘traditional’ and intentional harm to children and women – but also to significant numbers of adult men (just one example: climate change).

Patriarchy is vitally about power, and its unequal distribution. Perhaps the JME authors prefer not to think about the complexities of power, but it shapes everything we are considering in this discourse. It is surely not of itself an imperialist, racist or unreasonable position to insist that powerful forces are made apparent when the subject under discussion is the health and well-being of women and children? It is however at best very odd in such a long and detailed paper as the JME essay to dismiss this topic simply via one throw-away comment that “Political patriarchy may have very little to do” with local social norms and stereotypes, or whatever.

Whilst much more could be said, perhaps it is enough for now to ask that the authors of Harms of the current global anti-FGM campaign consider again the power aspects of their analysis. In ignoring this critically fundamental aspect of all human interactions, including clinically inessential human body incursions, the debate about how to name them becomes almost an irrelevance.

It is perfectly possible to use respectfully whatever term a person with or without FGM / circumcision / genital ‘practices’ prefers, whilst also in professional wider public discourse agreeing that all such incursions are damaging in at least some respects: they are F [or M] GM. Such naming does not exclude sensitive and careful thought about why these phenomena occur; it is time for these already extant debates to be welcomed and properly attended to, not denied as though so far they do not exist.

Public Health, the media and the backlash against women

Even if already important debates which deserve engagement remain unacknowledged, however, the current JME paper leaves aside the most fundamental point of all. It is the professional responsibility of everyone involved to promote the health and well-being of those for whom we care. What is needed is much more engagement with Public Health – whether in the Global South or in the Global North. To achieve this will require a new dialogue, ensuring that all aspects of human reproductive and sexual health, including FGM and MGM, are considered in the contexts of the environments (physical as well as socio-economic) in which they occur. That will require skills and knowledge way beyond a partisan ‘debate’ about terminology.

And in that dialogue the role of public officials and the media will, as the JME authors insist, be critical. These are the people who may determine, and can explain, what is happening and why. Instead of telling them what terms they may not use, let’s accord them too respect and also encourage them towards a positive perception of women wherever (and however) they live.

At a time when the backlash against women is becoming stronger by the day, we need not to disparage mainstream thought leaders, but to collaborate and work with them all to ensure that the great strides towards gendered fairness and the intolerance of violence against women and girls are not lost in an unwinnable war of words about terminologies (however significant in the view of detractors) and attitudes.

Some of course will continue to insist loudly that only their interpretation of terminologies is valid, and this is therefore a prime consideration. Others will say more calmly that yes, there are ‘issues’ to be debated, but these must not obscure the reality that people die, or live miserably grim lives, as a result of FGM.

The role here of properly resourced Public Health is to show in practical ways that we mean business – fairness and living safe from harm for everyone, and respect for women and men, girls and boys wherever they may be. That must surely be our prime focus at a time when, alongside other significant harms to women and men alike, there are still hundreds of millions of women and girls living on the globe with FGM.

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For more information about FGM please see: “What we know about female genital mutilation – A summary (2025) of the many and complex aspects” and the 2025 IHPE Position Statement: female genital mutilation (FGM).

Declaration of Interest: The author declares no declaration of interest.

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Your Comments (see as below) on this topic are welcome.  
Please post them in the Reply box which follows these announcements…..

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Books by Hilary Burrage on female genital mutilation

https://orcid.org/0000-0002-6684-2740

Eradicating Female Genital Mutilation: A UK Perspective
Ashgate / Routledge (2015)  Reviews

A free internet version of the book Female Mutilation is available

here.

[It is hoped that putting all these global Female Mutilation narrations onto the internet will enable readers to consider them via Google Translate in whatever language they choose.]

Hilary has published widely and has also contributed two chapters to Routledge International Handbooks:

Female Genital Mutilation and Genital Surgeries: Chapter 33,
in Routledge International Handbook of Women’s Sexual and Reproductive Health (2019),
eds Jane M. Ussher, Joan C. Chrisler, Janette Perz
and
FGM Studies: Economics, Public Health, and Societal Well-Being: Chapter 12,
in The Routledge International Handbook on Harmful Cultural Practices (2023),
eds Maria Jaschok, U. H. Ruhina Jesmin, Tobe Levin von Gleichen, Comfort Momoh

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PLEASE NOTE:

The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children, which has a primary focus on FGM, is clear that in formal discourse any term other than ‘mutilation’ concedes damagingly to the cultural relativists. ‘FGM’ is therefore the term I use here  – though the terms employed may of necessity vary in informal discussion with those who by tradition use alternative vocabulary. See the Feminist Statement on the Naming and Abolition of Female Genital Mutilation,  The Bamako Declaration: Female Genital Mutilation Terminology and the debate about Anthr/Apologists on this website.

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This article concerns approaches to the eradication specifically of FGM.  I am also categorically opposed to MGM, but that is not the focus of this particular piece, except if in any specifics as discussed above.

Anyone wishing to offer additional comment on more general considerations around male infant and juvenile genital mutilation is asked please to do so via these relevant dedicated threads.

Discussion of the general issues re M/FGM will not be published unless they are posted on these dedicated pages. Thanks.