What Physiotherapists Need to Know About Female Genital Mutilation

On May 31, 2022, the Health Professions (Protecting Women and Girls) Amendment Act (formerly Bill 10) received Royal Assent. The Act amended the Health Professions Act by:

• Adding prohibitions to female genital mutilation when performed by health professionals regulated under the Health Professions Act,
• Prohibiting individuals convicted of a criminal offence related to the procurement or performance of female genital mutilation in another jurisdiction from registration in Alberta,
• Establishing mandatory reporting requirements related to female genital mutilation for registrants and employers, and
• Requiring that health professions regulators established under the Health Professions Act develop standards of practice regarding female genital mutilation.

What is Female Genital Mutilation?

According to the Society of Obstetricians and Gynaecologists of Canada (SOGC), “there is no international consensus on what to call the practice of physically altering girls’ and women’s genitals. The current most commonly used terms in the literature are “female circumcision,” “female genital mutilation” (FGM), and “female genital cutting” (FGC).”¹

According to the World Health Organization (WHO), female genital mutilation is “mostly carried out on young girls between infancy and adolescence, and occasionally on adult women.”²

Female genital mutilation “comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.”² The WHO categorizes female genital mutilation into four types:²

Type 1

This is the partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals), and/or the prepuce/clitoral hood (the fold of skin surrounding the clitoral glans).

Type 2

This is the partial or total removal of the clitoral glans and the labia minora (the inner folds of the vulva), with or without removal of the labia majora (the outer folds of skin of the vulva).

Type 3

Also known as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoral prepuce/clitoral hood and glans.

Type 4

This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g., pricking, piercing, incising, scraping and cauterizing the genital area.

According to the SOGC:

• “Female genital cutting continues to be practiced in many countries, particularly in sub-Saharan Africa, Egypt, and Sudan.
• Global migration patterns have brought female genital cutting to Europe, Australia, New Zealand, and North America, including Canada.
• There is concern that female genital cutting continues to be perpetuated in receiving countries, mainly through the act of re-infibulation.”¹

Female genital mutilation is identified as a form of aggravated assault under Section 268 (3) of the Criminal Code of Canada.

What does the Health Professions (Protecting Women and Girls) Amendment Act³ Require?

For the purposes of the Health Professions (Protecting Women and Girls) Amendment Act

“female genital mutilation” means the excision, infibulation or mutilation, in whole or in part, of the labia majora, labia minora, clitoral hood or clitoris of a person, except where valid consent is given, and

(i) a surgical or other procedure is performed by a regulated member under this Act for the benefit of the physical health of the person or for the purpose of that person having normal reproductive functions or normal sexual appearance or function, or

(ii) the person is at least 18 years of age and there is no resulting bodily harm;³

Prohibitions

• Regulated physiotherapists are prohibited from procuring or performing female genital mutilation.
• Individuals who have been convicted of a criminal offence related to the procurement or performance of female genital mutilation are not eligible for registration as a health professional under the Health Professions Act.

Mandatory Reporting

• A regulated member who, in the course of acting in their professional capacity, has reasonable grounds to believe that the conduct of another regulated member of any College constitutes the procurement or performance of female genital mutilation, must report that conduct to the Complaint Director of the regulated member’s College. (HPA Section 127.2 (1))
• An employer who has reasonable grounds to believe that a regulated member has procured or performed female genital mutilation must, as soon as possible, notify the Complaint Director of the regulated member’s College. (HPA Section 57 (1.2))

Standard of Practice

The Health Professions (Protecting Women and Girls) Amendment Act requires that Colleges develop Standards of Practice regarding female genital mutilation. Council is required to adopt these standards within 12 months of the coming into force of the legislative amendments.

As a result, the College is adding requirements regarding female genital mutilation to the Standards of Practice. The following performance expectations will come into force on May 31, 2023, in accordance with the requirements of the legislation.

Female Genital Mutilation

Section 133.2 of the Health Professions Act requires that Colleges establish standards of practice regarding female genital mutilation.

The physiotherapist:

• Must not procure or perform female genital mutilation.
• Reports all instances where the physiotherapist has reasonable grounds to believe that the conduct of another regulated member of any College constitutes the procurement or performance of female genital mutilation to the Complaints Director of the other regulated member’s College.

What this Means for Alberta Physiotherapists

The College is confident that regulated physiotherapists abide by the laws of Canada and do not procure or perform female genital mutilation. The addition of the prohibition against performing or procuring female genital mutilation by regulated physiotherapists within the Standards of Practice, registration prohibitions, and mandatory reporting requirements as required by legislation will serve to reinforce pre-existing professional expectations.

Alberta physiotherapists are advised to familiarize themselves with:

• The definition of female genital mutilation contained within the Act and with the procedures which constitute female genital mutilation.
• The exclusions to the definition of female genital mutilation contained within the Act.
• Information available from credible sources such as the SOGC and the WHO regarding the prevalence, complications and risks, and socio-cultural considerations related to female genital mutilation.

As highlighted by the SOGC,¹

“The practice continues to be perpetuated due to an array of complex social, religious, and cultural reasons intrinsically linked to traditional beliefs, values, and attitudes related to women’s sexuality and the perceived need to control their sexual and reproductive capacity. Parents submit their daughters to FGC not as means of punishment or abuse, but as a way to protect them and give them ‘the best possible chance to have a future that will ensure [their] social acceptance and economic security.’” [UNICEF Office of Research, cited by SOGC]

Alberta physiotherapists should consider their practice, patient populations served and the risk that one of their patients may have experienced or may be at risk of experiencing female genital mutilation. Physiotherapists should reflect on how they would respond in a sensitive and respectful manner to a situation where they became aware that a patient had experienced or was at risk of experiencing female genital mutilation while also fulfilling the obligations established by the legislation.

Page updated: 06/04/2023