Female Genital Cutting (FGC) and the ethics of care: community engagement and cultural sensitivity at the interface of migration experiences.
BACKGROUND
Female Genital Cutting (FGC) anchored in a complex socio-cultural context becomes significant at the interface of access of health and social services in host countries. The practice of FGC at times, understood as a form of gender-based violence, may result in unjustifiable consequences among girls and women; yet, these practices are culturally engrained traditions with complex meanings calling for ethically and culturally sensitive health and social service provision. Intents and meanings of FGC practice need to be well understood before before any policies that criminalize and condemn are derived and implemented. FGC is addressed as a global public health issue with complex legal and ethical dimensions which impacts ability to access services, far beyond gender sensitivity. The ethics of terminology are addressed, building on the sustained controversial debate in regards to the delicate issue of conceptualization. An overview of international policies is provided, identifying the current trend of condemnation of FGC practices. Socio-cultural and ethical challenges are discussed in light of selected findings from a community-based research project. The illustrative examples provided focus on Western countries, with a specific emphasis on Canada.


CONCLUSIONS
The examples provided converge with the literature confirming the utmost necessity to engage with the FGC practicing communities allowing for ethically sensitive strategies, reduction of harm in relation to systems of care, and prevention of the risk of systematic gendered stigmatization. A culturally competent, gender and ethically sensitive approach is argued for to ensure the provision of quality ethical care for migrant families in host countries. We argue that socio-cultural determinants such as ethnicity, migration, sex and gender need to be accounted for as integral to the social construction of FGC.


CONCLUSIONS
Working partnerships between the public health sector and community based organisations with a true involvement of women and men from practicing communities will allow for more sensitive and congruent clinical guidelines. In order to honour the fundamental principles and values of medical ethics, such as compassion, beneficence, non-malfeasance, respect, and justice and accountability, socio-cultural interactions at the interface of health and migration will continue to require proper attention. It entails a commitment to recognise the intrinsic value and dignity of girls' and women's context.
Faculty of Nursing, Université de Montréal, PO Box 6128, Station Centre-Ville-Montréal, QC H3C 3J7, Canada. bilkis.vissandjee@umontreal.ca.
Bilkis
B
Vissandjée
Shereen
S
Denetto
Paula
P
Migliardi
Jodi
J
Proctor
D000328:Adult; D002170:Canada; D002648:Child; D019093:Circumcision, Female; D055812:Community-Based Participatory Research; D032882:Comprehension; D054521:Cultural Competency; D003695:Delivery of Health Care / Q000941:ethics*; D034462:Dissent and Disputes; D054242:Emigrants and Immigrants; D004992:Ethics, Medical; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D011634:Public Health; D012111:Residence Characteristics; D057545:Social Stigma; D014754:Violence; D016387:Women's Health