The Acton Model: support for women with female genital mutilation

Female genital mutilation (FGM) is a global healthcare problem affecting an estimated 200 million women and girls, worldwide (World Health Organization [WHO], 2016). It is defined as ‘all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons’ (WHO, 2016). The WHO classifies FGM into four types, which cause varying levels of trauma to female genitalia. These have been further subdivided to ‘capture the varieties of FGM in more detail’ (WHO, 2020a; Table 1). Type 3 FGM or ‘phaoronic circumcision’, in particular, involves sealing the vulva and often requires a minor surgical procedure (deinfibulation) to facilitate menstruation, urination, penetrative sexual intercourse and childbirth.

The WHO recently estimated that ‘treatment of health complications of FGM in 27 high prevalence countries costs 1.4 billion USD per year’ (WHO, 2020a). A report commissioned by the Department of Health estimated the ‘annual cost of care for women with FGM in England and Wales at £100 million’ (Hex et al, 2016), suggesting that deinfibulation and psychological interventions may reduce long term costs to the NHS by treating complications in pregnancy (such as increased risk of tears, postpartum haemorrhage, longer maternal stay and higher caesarean section rates); uro-gynaecological problems (including recurrent urinary tract infections, thrush infections, dysuria, dysmenorrhea, dyspareunia and infertility); and by mediating the psychological impact (post-traumatic stress disorder, anxiety and depression) (WHO, 2016).