School doctors in the Netherlands should examine the genitalia of girls aged 6, 9, and 13 years, as part of regular health checks. This is the proposal of a government advisory body to tackle the illegal practice of female genital mutilation.
The proposals are being opposed by a wide range of doctors' organisations, which say that they would damage the widespread coverage that the school health services presently achieve and would drive the problem further underground.
In its report, the Council for Public Health and Care also recommends that doctors should be legally obliged to report cases. The report estimates there are 50 cases of female circumcision a year in the Netherlands. This is based on two representative studies in, Amsterdam and Tilburg, of immigrant populations from Saharan countries where female circumcision is traditional.
But the Royal Dutch Medical Association, the Dutch child health association, and the Dutch tropical medicine society argue that emphasising prosecution rather than prevention may jeopardise the 95% coverage of health checks for schoolchildren.
The report follows a call by MPs for annual obligatory health checks of groups that are at risk. Consequently, the health minister Hans Hoogervorst asked the council to consider how best to enforce the legal ban on female genital mutilation.
The report rejected calls for obligatory targeted checks as undesirable. It instead recommended intensifying youth health care with regular physical examination of external genitalia at school health clinics at ages 6, 9, and 13 years. Health professionals, given greater expertise, could, it argues, “Bring problems into the open more often.” Although checks are not obligatory, parents who consistently withdraw their children could be reported for child abuse.
The report says that medical professionals should report all diagnoses of female genital mutilation to a register, which, in turn, reports such cases to the public prosecution service. The code of the Royal Dutch Medical Association says that doctors should report cases only if they believe it is justified to protect the interests of a child.
An obligation to report mutilation removes uncertainty for doctors, which could improve the trust of their patients, said a spokeswoman for the council. Regular health checks have advantages for a range of medical issues that outweigh any disadvantages. “We currently have 50 cases of female circumcision a year. Our youth deserve better,” she said.
But the child health association has grave doubts about increasing the number of “very burdensome” physical examinations. Wike Lijs-Spek, chairwoman of the association, said, “Our work is prevention. We signal problems. If we see a girl at risk we can help her. If we have to act as a sort of police we could now lose contact with children. Some just won't come.”
Louis Niessen, chairman of the tropical medicine society, argued that the proposed screening of schoolchildren is primarily to deter and detect crime. He stressed the importance of building good relationships with target groups and affected girls to allow for prevention and care: “This measure is counterproductive in that it would ruin this relationship.” The government is expected to respond to the recommendations in May.
The report, Bestrijding Vrouwelijke Genitale Verminking [Combating Female Genital Mutilation], is available at www.rvz.net.