Legal and medical bases for granting asylum in the USA to women with female genital mutilation: a systematic review

Abstract

BackgroundA precedent exists for granting asylum based on fear of persecution in the form of female genital mutilation (FGM), but it does not apply to women who have already undergone FGM on the logic that they have no grounds to fear further persecution. I assessed the published work about whether women who have already undergone FGM should be granted asylum to the USA on the basis of the medical consequences of the procedure. MethodsI searched legal and medical databases (HeinOnline and PubMed) for the terms: “asylum and female genital mutilation”, “health consequences of female genital mutilation”, “mental health consequences of female genital mutilation”, and “PTSD and female genital mutilation”. All articles published since 1994 were screened. In the legal database, only documents fitting the description “articles”, rather than “notes” or “commentaries”, were screened. I excluded: articles about asylum or FGM but not about both, articles that did not discuss asylum for women who have already undergone FGM, articles that relayed anecdotes about treatment or clinical advice for patients who have undergone FGM, articles about countries other than the USA, and articles analysing women's and health-care providers’ attitudes toward FGM. Articles had to be about FGM in particular and not about other forms of violence against women. FindingsThe database searches yielded 1007 articles. Most articles (n=881) were from the legal database. The final analysis included 35 articles. The medical—especially obstetric—complications associated with FGM can be severe but might be reduced by deinfibulation, which is done in the USA. Women who are forced to return to their native countries might be subject to a repeat FGM procedure. Furthermore, return to the scene of FGM engenders substantial risk of worsening trauma-related psychiatric illness. InterpretationWomen who have already undergone FGM should have the right to be granted asylum in the USA on the basis of significant threats to their physical and mental health if returned to their native countries. FundingNone.