Healthcare and community perspectives on female genital mutilation/cutting (FGM/C): a qualitative study

Female genital mutilation/cutting (FGM/C) continues to pose a significant global public health challenge. Millions of women and girls affected by this practice face challenges in accessing adequate healthcare and support services, underscoring the critical need for further ongoing research, the development of comprehensive policies, and evidence-based clinical guidelines to ensure the provision of the highest attainable quality of care while advancing international efforts to eliminate FGM/C worldwide. Guided by the social ecological framework (SEM), this exploratory qualitative study aimed to explore who and what controls the practice and continuation of FGM/C, its medicalisation, associated health impacts, healthcare, and potential prevention strategies.

This qualitative descriptive study was conducted among Ethiopians living in Australia between 2024 and 2025. Semi-structured interviews were conducted in Amharic with 23 purposively selected participants, including professionals with expertise and experience in FGM/C and non-professionals with lived cultural knowledge and experience. The study employed SEM to explore multi-level drivers influencing the practice, impacts, medicalisation, healthcare needs, and prevention strategies related to FGM/C. Data were analysed using Braun and Clarke's reflexive thematic analysis framework supported by NVivo-14 software.

Results from the thematic analysis, guided by the SEM, revealed interconnected drivers and impacts of FGM/C across multiple levels. At the individual level, FGM/C was linked to a lack of bodily autonomy for women and girls, significant health consequences, and substantial unmet healthcare needs. At the interpersonal level, FGM/C was described as both a rite of passage and an inherited family tradition, reinforced by family and peer pressure, misconceptions, myths, and fear of social rejection. At the community level, FGM/C was deeply rooted in sociocultural norms, seen as a way of protecting girls from sexual violence and rape and ensuring marriageability. At the institutional and policy level, challenges included the medicalisation of FGM/C, complexities surrounding deinfibulation and reinfibulation, and the challenges to prevention and elimination strategies.

The findings demonstrated that the key drivers and impacts of FGM/C are intertwined across various levels of the SEM, emphasising the need for multi-level strategies in healthcare, prevention, and elimination efforts.

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