Debating medicalization of Female Genital Mutilation/Cutting (FGM/C): learning from (policy) experiences across countries.

BACKGROUND: Although 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 BODY: The 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. CONCLUSION: More 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.

The evolution of birth medicalisation: A systematic review.

First described at the beginning of the 1970s, the concept of birth medicalisation has experienced a theoretical and ideological evolution influenced by the lines of research that have been associated with it. This evolution has given rise to different schools of thought concerning medicalisation, but also various methodologies used in different scientific fields. It seems relevant to propose a global synthesis of the various lines of thought related to birth medicalisation. To do this, the authors conducted a systematic literature review based on the PRISMA method. With a total of 38 occurrences in French and English, the authors scrutinised 17 databases with a publication period between 1995 and 2018. A total of 112 documents (107 articles, 3 book chapters, 2 books) has been identified, grouped and categorised into five main themes in the results section (1) the theoretical evolution of the concept of medicalisation, (2) factors related to the birth medicalisation, (3) the impact of the birth medicalisation, (4) the humanisation of birth and (5) experiences related to childbirth. A reasoned synthesis of the literature is therefore carried out in each part and then discussed according to the selected lines of research that require development in order to guarantee the best possible accompaniment to women who give birth.

Why is quaternary prevention important in prevention?

Quaternary prevention consists in the identification of persons at risk of excessive medicalization and their protection against new unnecessary interventions, avoiding iatrogenic damages. Here, we argue about the importance of quaternary prevention in specific primary and secondary prevention. The recent great development of preventive medicine, biomedicalization of risks and their treatment as if they were diseases, and the powerful influence of the commercial interests of pharmaceutical industries on the production of medical-sanitary knowledge alter classifications, create diseases and pre-diseases, lower cutoff points, and erase the distinction between prevention and healing. This situation converts larger amounts of asymptomatic persons into sick individuals and diverts clinical attention and resources from sick persons to the healthy, from older adults to young persons, and from the poor to the rich. Quaternary prevention facilitates and induces the development and systematization of operational knowledge and guidelines to contain hypermedicalization and the damages of preventive actions in professional care, especially in primary health care.

Why is quaternary prevention important in prevention? / Por que é importante a prevenção quaternária na prevenção?

ABSTRACT Quaternary prevention consists in the identification of persons at risk of excessive medicalization and their protection against new unnecessary interventions, avoiding iatrogenic damages. Here, we argue about the importance of quaternary prevention in specific primary and secondary prevention. The recent great development of preventive medicine, biomedicalization of risks and their treatment as if they were diseases, and the powerful influence of the commercial interests of pharmaceutical industries on the production of medical-sanitary knowledge alter classifications, create diseases and pre-diseases, lower cutoff points, and erase the distinction between prevention and healing. This situation converts larger amounts of asymptomatic persons into sick individuals and diverts clinical attention and resources from sick persons to the healthy, from older adults to young persons, and from the poor to the rich. Quaternary prevention facilitates and induces the development and systematization of operational knowledge and guidelines to contain hypermedicalization and the damages of preventive actions in professional care, especially in primary health care.

RESUMO A prevenção quaternária consiste na identificação de pessoas em risco de medicalização excessiva e sua proteção contra novas intervenções desnecessárias, evitando danos iatrogênicos. Aqui, argumentamos sobre a importância da prevenção quaternária na prevenção primária específica e secundária. O grande desenvolvimento recente da medicina preventiva, da biomedicalização dos riscos e seu tratamento como se fossem doenças e a influência poderosa dos interesses comerciais das indústrias farmacêuticas sobre a produção de conhecimento médico-sanitário alteram classificações, criam doenças e pré-doenças, rebaixam pontos de corte e apagam a distinção entre prevenção e cura. Isso converte maiores proporções de pessoas assintomáticas em doentes e desvia a atenção clínica e os recursos dos mais doentes para os saudáveis, dos idosos para os jovens e dos pobres para os ricos. A prevenção quaternária facilita e induz o desenvolvimento e sistematização de saberes e diretrizes operacionais para a contenção da hipermedicalização e dos danos das ações preventivas no cuidado profissional, sobretudo na atenção primária à saúde.

Fatness, medicalization, and stigma: on the need to do better.

This article comments on a collection of remarkable narratives authored by fat writers addressing the American Medical Association's decision to label obesity a disease. Endeavoring to avoid what has been termed "thinsplaining," the commentary examines the voices of the writers in the hopes of identifying key themes and points that emerge from these fat narratives. The commentary canvasses the writers' perspectives on topics such as the medicalization and pathologization of fat, the Western and especially American tendency to emphasize individual culpability for fatness, and, of course, the horrific commonality and intensity of fat stigma. Stigma is a particular focus for the commentary, both because it is a principal theme in the collection, and also because it is important to understand precisely what stigma is and its deep connections to larger macrosocial structures. The commentary concludes with a simple admonition, gleaned from the narratives: we should strive to do better.

Integration of mental health into primary healthcare in low-income countries: avoiding medicalization.

Since 2008 the World Health Organization (WHO), through its mental health Gap Action Programme, has attempted to revitalize efforts to integrate mental health into non-specialized (e.g. primary) healthcare. While this has led to renewed interest in this potential method of mental health service delivery, it has also prompted criticism. Some concerns raised are that it would contribute to the medicalization of social and psychological problems, and narrowly focus on primary care without sufficient attention given to strengthening other levels of the healthcare system, notably community-based care and care on district levels. This paper discusses seven elements that may be critical to preventing inadvertently contributing to increasing a narrow biomedical approach to mental healthcare when integrating mental health into non-specialized healthcare: (1) using task shifting approaches within a system of stepped care, (2) ensuring primary mental healthcare also includes brief psychotherapeutic interventions, (3) promote community-based recovery-oriented interventions for people with disabling chronic mental disorders, (4) conceptualizing training as a continuous process of strengthening clinical competencies through supervision, (5) engaging communities as partners in psychosocial interventions, (6) embedding shifts to primary mental healthcare within wider health policy reforms, and (7) promoting inter-sectoral approaches to address social determinants of mental health.