When Survivors Lead: Ending Female Genital Mutilation Through Health Systems Accountability

6 February 2026

 

By Mariam Dahir and Catherine Chacha Menganyi

 Dr. Mariam Dahir is a Somali doctor, researcher and anti-female genital mutilation activist. She is part of the small team that drafted the law against FGM in Somaliland. Dr Dahir is also the co-founder of Women in Global Health Somalia.

 Ms. Catherine Chacha Menganyi HSC  is Migori County’s Gender-Based Violence Coordinator and Chapter Lead for Women in Global Health Kenya. She is a public health specialist, nurse epidemiologist, and gender justice advocate. 

Female genital mutilation (FGM) is often discussed in statistics: more than 230 million girls and women have undergone the practice worldwide, and four million girls are at risk every year. These numbers matter, but they do not tell the whole story. They do not capture the pain carried in our bodies, the silence imposed on our voices, or the moment when we, as health care workers and survivors, decided that survival was not enough. Leadership is required.

We write this as women who live at the intersection of lived experience and professional responsibility. We are survivors of FGM. We are also healthcare workers. We know, intimately and professionally, the harm FGM causes, and the power of health systems to either perpetuate that harm or help end it. From harm to healing and accountability.

For many survivors, health facilities are the first place where the consequences of FGM become visible: complications during menstruation, pregnancy, childbirth, or sexual health care; infections; chronic pain; trauma. Too often, these encounters are marked by stigma, silence, or normalization of the practice. Too often, survivors are treated as clinical cases rather than rights-holders.

This is why the medicalization of FGM is so deeply troubling. An estimated one in four cases of FGM globally is now performed by a health care provider. This is sometimes justified as “harm reduction.” From our perspective, this framing is dangerous. There is no safe form of FGM. When health systems participate in the practice, they do not reduce harm; they legitimize it.

As health workers, we are bound by ethics: do no harm. Ending FGM requires health systems to uphold this principle without exception.

Why Survivors Must Be at the Centre

Survivors are not passive recipients of care. We are experts in our own lives. When survivors are meaningfully involved in shaping policies, services, and accountability mechanisms, the quality and credibility of responses improve.

Meaningful participation means more than consultation. It means:

• Survivors involved in policy, legislation, and program design, not just implementation;
• Survivors are represented in the training of health workers, regulators, and policymakers;
• Survivors engaged in monitoring and accountability, including feedback mechanisms for health services and community oversight; and
• Survivors are supported, not exploited, to speak – guided by safeguards, dignity, and choice.

When survivors lead, services become more compassionate, laws become more enforceable, and communities begin to shift.

Health Workers as Agents of Change

Women make up the majority of the global health and care workforce. This places women’s health workers in a uniquely powerful position. We are often trusted members of our communities. Our words carry weight. Our silence does too.

Ending FGM within health systems requires:

• Clear zero-tolerance policies against all forms of FGM, including medicalization;
• Strong professional regulation and sanctions for violations;
• Mandatory pre-service and in-service training grounded in human rights and gender equality;
• Integration of survivor-centred, and trauma-informed care standards into health services; and
• Safe whistle-blowing and reporting mechanisms, accessible to both patients and providers.
  

Health workers must be supported to act ethically, even when community pressure is strong. This is not an individual failing; it is a system’s responsibility.

Law, Policy, and Practice Must Work Together

Laws banning FGM matter. They signal that FGM is unacceptable and that girls’ and women’s bodily autonomy is not negotiable. But laws alone are not enough.

Across contexts, we have seen that legal frameworks are effective only when paired with:

• Consistent enforcement and access to justice;
• Adequate budgeting for implementation, survivor services, and prevention;
• Community engagement led by women and girls; and 
• Alignment with international commitments, including the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Convention on the Rights of the Child (CRC).
  

Recent legal developments in Africa, including strategic litigation before regional courts, demonstrate the power of feminist advocacy to strengthen accountability. But these gains remain fragile without sustained political will and financing.

Confronting the Backlash

Efforts to eliminate FGM do not exist in a vacuum. They are unfolding amid a broader backlash against gender equality, bodily autonomy, and women’s rights. Anti-rights movements are increasingly organized, well-resourced, and vocal.

In this context, protecting progress on FGM requires courage. It requires governments to stand firm, donors to stay engaged, and civil society, especially feminist and women-led organizations, to be supported rather than sidelined.

It also requires investing in adolescent girls as leaders. Girls are already challenging harmful gender norms in their schools, families, and communities. But engagement must be safe, ethical, and empowering, not extractive or symbolic.

Investing in What Works

Ending FGM by 2030 is possible, but only if commitments are matched with resources. Yet less than one per cent of bilateral aid currently reaches women’s rights organisations. At the same time, official development assistance is projected to decline further.

When funding is short-term or fragmented, programmes collapse, and girls pay the price.

Investment must prioritize:

• Girl- and women-led and survivor-led organizations
• Long-term prevention and norms-change programs
• Health systems strengthening and accountability
• Survivor services, including mental health and legal support.
  

A Call to Action

As survivors and health care workers, we call on governments, donors, and institutions to act with urgency and integrity:

• End the medicalization of FGM, without exception.
• Fund women’s leadership, without hesitation.
• Center survivors, not just in words, but in power and resources.

FGM is not inevitable. It persists because systems allow it to persist. Those systems can, and must, change.

We know this, because we have lived it. And we are leading that change.