Health systems approaches and other multisectoral efforts for primary prevention of female genital mutilation and clinical management of its complications.

BACKGROUND: Female genital mutilation (FGM) affects more than 230 million girls and women globally and poses substantial public health, human rights, and gender-equality challenges. While community and legislative initiatives remain central to elimination efforts, emerging evidence underscores the pivotal role of health systems in prevention, clinical management, and rights-based support for survivors.

OBJECTIVES: This editorial synthesizes findings from six systematic and mixed-method reviews that inform the 2025 WHO guideline on the prevention of FGM and the management of its complications, with a focus on community interventions, health-worker capacity building, legal and policy frameworks, deinfibulation, clitoral reconstructive surgery, and non-surgical sexual-health interventions.

RESULTS: Evidence suggests that community education may shift knowledge and attitudes supporting abandonment. Training improves provider knowledge and confidence but requires stronger ethical and regulatory alignment. Laws and professional codes influence provider behavior but may generate unintended harms without clear guidance. Clinical interventions, including deinfibulation and reconstructive surgery, show potential benefits but are supported by low-certainty and methodologically limited evidence. Research on non-surgical sexual-health interventions is minimal.

CONCLUSIONS: Eliminating FGM and improving survivor care require an integrated health-systems approach, aligned legal and professional frameworks, and survivor-centered, methodologically robust research to guide prevention, clinical management, and ethical practice.