Female genital mutilation/cutting (FGM/C) is the nontherapeutic alteration of the external female genitalia. It occurs globally but is most prevalent in parts of Africa, Asia, and the Middle East. Globally, FGM/C is considered an act of gender-based violence and is a federal crime in the United States and Canada. The WHO (World Health Organization) classifies FGM/C into four subtypes to standardize diagnosis, documentation, and management. Type 3, also known as infibulation, is considered the most severe subtype. There are infectious, urologic, obstetric, and psychological complications, especially with Types 2 and 3 FGM/C. Recommendations for management of FGM/C Type 3 (infibulation) consist of restoration of the external genitalia by defibulation. Holistic and culturally competent care should drive the overall management approach. In addition to surgical management to restore the external genitalia, comprehensive care should include ongoing counseling, psychosocial support, and comprehensive obstetric and gynecologic care.

This chapter provides an overview of female genital mutilation (FGM) and how it affects maternity care. FGM is when the female genitals are deliberately cut or injured without medical reason. It is deeply entrenched in gender inequality and is recognised as a human rights’ violation. An estimated 200 million women and girls worldwide live with the physical and psychological consequences of FGM. Four types are classified by the World Health Organization. Careful antenatal assessment should include diagnosis of FGM type, birth plan and safeguarding assessment. Women with FGM are more likely to have adverse obstetric outcomes than women without FGM. Women with Type 3 FGM may require a procedure called deinfibulation to open the anterior scar to facilitate childbirth. This can be carried out during the antenatal or intrapartum period. Many countries have made FGM illegal but the practice still persists across the world.