BackgroundAlthough Female Genital Mutilation/Cutting (FGM/C) is internationally considered a harmful practice, it is increasingly being medicalized allegedly to reduce its negative health effects, and is thus suggested as a harm reduction strategy in response to these perceived health risks. In many countries where FGM/C is traditionally practiced, the prevalence rates of medicalization are increasing, and in countries of migration, such as the United Kingdom, the United States of America or Sweden, court cases or the repeated issuing of statements in favor of presumed minimal forms of FGM/C to replace more invasive forms, has raised the debate between the medical harm reduction arguments and the human rights approach.Main bodyThe purpose of this paper is to discuss the arguments associated with the medicalization of FGM/C, a trend that could undermine the achievement of Sustainable Development Goal 5.3. The paper uses four country case studies, Egypt, Indonesia, Kenya and UK, to discuss the reasons for engaging in medicalized forms of FGM/C, or not, and explores the ongoing public discourse in those countries concerning harm reduction versus human rights, and the contradiction between medical ethics, national criminal justice systems and international conventions. The discussion is structured around four key hotly contested ethical dilemmas. Firstly, that the WHO definition of medicalized FGM/C is too narrow allowing medicalized FGM to be justified by many healthcare professionals as a form of harm reduction which contradicts the medical oath of do no harm. Secondly, that medicalized FGM/C is a human rights abuse with lifelong consequences, no matter who performs it. Thirdly, that health care professionals who perform medicalized FGM/C are sustaining cultural norms that they themselves support and are also gaining financially. Fourthly, the contradiction between protecting traditional cultural rights in legal constitutions versus human rights legislation, which criminalizes FGM/C.ConclusionMore research needs to be done in order to understand the complexities that are facilitating the medicalization of FGM/C as well as how policy strategies can be strengthened to have a greater de-medicalization impact. Tackling medicalization of FGM/C will accelerate the achievement of the Sustainable Development Goal of ending FGM by 2030.

Background Female genital mutilation (FGM) is a harmful cultural practice that is predominantly documented in Africa, but also occurs in other parts of the world. Due to migration, women who have undergone FGM can also be found in the European Union (EU). Due to a lack of systematic representative surveys on the topic in EU, the prevalence of FGM and the number of women and children subjected to the practice remains unknown. However, information on the magnitude of the problem in the EU is necessary for policy makers to design and track preventive measures and to determine resource allocation. Methods Between March 2015 and May 2015, we performed a situation analysis consisting of a critical interpretive synthesis and SWOT-analysis of available at the time peer reviewed and grey literature document on national prevalence studies on FGM in the EU. Studies estimating the prevalence of FGM and the number of girls and women subjected to the practice in the EU were mapped to analyse their methodologies and identify their Strengths, Weakness, Opportunities and Threats (SWOT). Distinction was made between direct and indirect estimation methods. Results Thirteen publications matched the prioritized inclusion criteria. The situation analysis showed that both direct and indirect methodologies were used to estimate FGM prevalence and the number of girls and women subjected to FGM in the EU. The SWOT-analysis indicated that due to the large variations in the targeted population and the available secondary information in EU Member States, one single estimation method is not applicable in all Member States. Conclusions We suggest a twofold method for estimating the number of girls and women who have undergone fgm in the EU. For countries with a low expected prevalence of women who have undergone fgm , the indirect method will provide a good enough estimation of the FGM prevalence. The extrapolation-of- fgm -countries-prevalence-data-method, based on the documented FGM prevalence numbers in DHS and MICS surveys, can be used for indirect estimations of girls and women subjected to FGM in the eu . For countries with a high expected prevalence of FGM in the EU Member State, we recommend to combine both a direct estimation method (e.g. in the form of a survey conducted in the target population) and an indirect estimation method and to use a sample design as developed by the FGM-PREV project. The choice for a direct or indirect method will ultimately depend on available financial means and the purpose for the estimation.

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CONTEXT : Women who seek abortion care beyond the fi rst trimester of gestation are often in a vulnerable socioeconomic position with limited social support, and in Belgium, the details of their circumstances are insuffi ciently understood. A better understanding of this group is essential to a critical evaluation of Belgian abortion policy, which restricts abortions on request after the fi rst trimester. METHODS :Anonymized patient records were collected between 2013 and 2016 from LUNA centers, which are nonhospital-based abortion clinics in Flanders. Logistic regression analyses were used to identify associations between women ' s characteristics and whether they presented within or beyond the legal limit, which was 13 weeks and 1 day at the time of the study. RESULTS :A total of 28,741 women requested an abortion, and 972 individuals (3.4%) presented beyond the legal limit; 29% of these latter women were unable to receive abortion care as a result of the mandatory six-day waiting period. Characteristics positively associated with presenting beyond the limit, instead of beforehand, were being younger than 20, as opposed to 20-24 (odds ratio, 1.7); receiving a primary, lower secondary, upper secondary or special-needs education, rather than a higher education (1.8-3.1); being unemployed, rather than employed (1.3); and holding Belgian rather than a foreign nationality (0.8). Being accompanied by someone to the LUNA center (0.8), having irregularly (0.6) or regularly used contraceptives (0.7), and having ever had an abortion (0.8) were negatively associated with presenting beyond, rather than before, the limit. CONCLUSIONS : A fuller consideration of patients' characteristics when evaluating Belgian abortion policy is needed to ensure that the needs and rights of socioeconomically vulnerable women are addressed.

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Today, female genital cutting is increasingly practised by trained healthcare providers. While opposition to medicalised female genital cutting (FGC) is strong, little is known about the underlying motivation for this medicalisation trend in practising communities. We formulated three

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