FGM Laws Protect Girls. Who Heals the Women?

Co-published with Equality Now.

Female genital mutilation (FGM) affects more than 230 million women and girls worldwide.  Egypt is home to one of the largest populations of survivors. Over the past decade, governments, civil society, and international partners have invested heavily in law reform, awareness, and prevention.

These efforts matter. But they leave a critical question unresolved: What obligations do states, health systems, and the international community owe the millions of women and girls already living with the consequences of FGM?

For survivors, the harm does not end with the cut. In my work with Equality Now across the Middle East and North Africa, I have seen how these consequences surface years later: during marriage, childbirth, or when untreated pain becomes normalized as something women must simply endure. Chronic pain, sexual dysfunction, childbirth complications, and long-term psychological trauma continue to shape everyday life. Yet recovery, medical, psychological, and social, remains one of the most neglected pillars of anti-FGM responses. If ending FGM is a matter of justice, then healing must be treated as a public responsibility, not a private burden.

FGM beyond criminalization: Why justice requires healing? 

Recognized internationally as a form of gender-based violence and a violation of human rights, FGM causes harm that extends across survivors’ entire lives. The World Health Organization classifies FGM into four types, and while the nature and severity of health impacts may vary by type, and medical evidence does not always sufficiently disaggregate long-term outcomes, research and survivor experiences consistently show that all forms of FGM can result in lifelong sexual, psychological, and potentially physical harm.

In FGM-prevalent contexts such as Egypt, where more women have undergone FGM than in any other country, survivors’ needs often become more visible or acute during key life stages, including marriage, childbirth, or when untreated pain and trauma become chronic.

Yet national strategies continue to frame FGM primarily as a criminal issue. While accountability is essential, laws alone do not repair harm. Equality Now’s global campaigning has long emphasized this gap: ending FGM requires not only stopping future violations, but addressing the lifelong impact on survivors through survivor-centered care, legal accountability, and systemic reform.

Does offering reconstructive surgery meaningfully expand survivor choice? And under what conditions might that choice be shaped by social or patriarchal expectations about women’s bodies? This is not an argument for or against reconstructive surgery itself, but for how states frame, regulate, and fund survivor care.

For some survivors, reconstructive procedures such as clitoral reconstruction or scar tissue release may offer relief from specific forms of pain or functional complications. For others, the benefits are limited or uncertain. Surgery cannot undo all physical damage, nor can it heal psychological trauma in isolation.

The ethical challenge is not whether surgery should be offered, but how it is framed. Without clear, realistic information, reconstructive surgery risks being presented as a cure rather than one possible option within a broader, trauma-informed approach to healing.

Dr. Reham Awad, Co-Founder of Restore FGM Clinic, an Egyptian Surgeon specializing in the clinical care of women affected by female genital mutilation, reflects on the importance of setting realistic expectations for survivors seeking reconstructive surgery: “What is essential during the rehabilitation phase is honesty about realistic outcomes. Reconstruction cannot return a woman’s body to a pre-FGM state. What it can do is improve the quality of life by addressing the complications we encounter—such as psychological distress, reduced sexual function, altered genital appearance, clitoral cysts, or urinary problems”.

She adds: “In many cases, we are able to improve sexual function, enhance the aesthetic appearance of the genitalia, and provide psychological support for survivors living with the consequences of FGM. The most meaningful results come when treatment follows a multidisciplinary approach. When medical care is combined with psychological support, the impact can be significant and life-changing for many women.”

Awareness without pressure: The hidden policy challenge

Across Egypt and many FGM-prevalent countries, awareness of reconstructive options remains limited and uneven. Survivors often learn about surgery informally, through NGOs or personal networks, rather than through trusted public health systems. This information gap leaves space for misinformation and inequity. In contexts where women’s sexual autonomy is already constrained, information about reconstructive surgery must be handled as a matter of rights, not persuasion.

At the same time, visibility carries its own risks. Awareness must not translate into social or marital pressure on women to “fix” their bodies in order to be accepted. Survivor choice, whether to pursue surgery or not, must remain central.

Reflecting on how survivors access information about reconstructive options within this constrained environment, Dr. Reham Awad explains: “Health systems in countries with high FGM prevalence have a clear responsibility to support survivors, both medically and psychologically. This requires well-trained healthcare professionals who can provide ethical, non-directive counseling grounded in survivors’ needs, not social expectations”.

Moreover, Dr. Awad explains, social pressure remains a major barrier to ending FGM, and changing these norms will take time. In the meantime, counseling should prioritize women who are already living with FGM-related complications, through psychosexual therapy and sexual education. These services can meaningfully improve survivors’ wellbeing without reinforcing pressure to conform to social or marital expectations.

Health systems that are not yet prepared

From a health system perspective, Dr. Reham Awad points to persistent gaps in training, protocols, and referral pathways: “Post-FGM reconstruction is a highly specialized field that requires extensive, dedicated training. FGM is rarely covered in medical education, and as a result, very few physicians globally are qualified to provide this care. The risks of inadequately trained surgeons attempting reconstructive procedures are serious—we regularly see cases where survivors suffer additional harm”.

According to Dr. Awad, in high-prevalence countries like Egypt, there is an urgent need for more thoroughly trained specialists and clear referral pathways. Evidence-based protocols now exist and should be implemented through multidisciplinary models of care, as they do at RESTORE. The current gaps lie in two areas: proper clinical training and broader awareness that medical and surgical care for FGM survivors is available. As she concludes, “women living with FGM deserve access to safe, informed, and specialized support.”

Even when survivors are aware of reconstructive options, cost is often the deciding barrier. For instance, in Egypt, surgery and associated care are largely out-of-pocket. Public insurance rarely covers these services, and indirect costs — transport, counseling, and time off work — further exclude low-income survivors.

As a result, access to healing becomes deeply unequal, turning justice into a matter of income rather than rights.

Women with financial means may pursue care; those without are left to endure untreated pain. If survivor rehabilitation is to be meaningful, it must be integrated into publicly funded health systems and supported by sustained donor investment.

The role of NGOs and philanthropic actors

Civil society organizations and philanthropic actors have played a critical role in filling gaps left by states, piloting survivor-centered medical and psychosocial services, supporting women through complex healing journeys, and generating evidence in contexts where official systems remain absent or unresponsive. In many FGM-prevalent countries, NGOs are the first, and sometimes only, entry point for survivors seeking information, referrals, and care. Their work has demonstrated that trauma-informed, rights-based rehabilitation is not only possible but effective when survivor choice is respected.

But NGOs cannot permanently substitute for state responsibility. When survivor rehabilitation depends on short-term grants or isolated projects, access to healing becomes fragile and unequal, programs start and stop, and justice turns into a matter of geography and funding cycles. Philanthropy and civil society should serve as catalysts for systemic change, not as safety nets that quietly absorb public neglect. If ending FGM is a public commitment, then healing from its consequences must be embedded in public health systems, national budgets, and long-term policy planning, with governments carrying the responsibility to sustain what civil society has proven can work.

Centering survivor voices in policy design

Survivors are not a homogeneous group. Some may choose reconstructive surgery and find it beneficial; others may reject it due to personal, cultural, medical, or financial reasons. Both perspectives are valid and must inform policy.

Drawing on years of clinical practice, Dr. Reham Awad emphasizes that survivor experiences consistently point to one critical truth: choice, dignity, and access to care, not the procedure itself, are what restore autonomy. She notes that many survivors describe FGM as a lifelong trauma, often marked by the same recurring memory: “I will never forget the day it happened.” The harm extends far beyond physical injury, affecting psychological well-being, self-worth, and intimate relationships well into adulthood.

For some women, learning that rehabilitation is possible, whether surgical, psychological, or educational, creates a profound shift. Survivors report feeling hope for the first time, regaining confidence, and reclaiming control over their bodies and lives. Clinical evidence supports these accounts, showing that reconstructive procedures, when chosen freely and supported by counseling, can significantly improve psychological well-being and quality of life.

Equally important are the women who do not pursue surgery. Dr. Awad stresses that many survivors benefit solely from sexual education, counseling, or referral to psychosocial support. Even the existence of a trusted, specialized center, where survivors are believed, informed, and respected, has a measurable positive impact on well-being.

At the same time, survivor stories also reveal the structural barriers policy must confront. Many women seek care in secrecy, fearing stigma, family backlash, or social repercussions. Others live for years with preventable complications simply because they were never told that care exists. These realities underscore that survivor-centered policy is not about promoting intervention, but about guaranteeing informed choice within safe, accessible systems.

Ending FGM requires prevention, accountability, and cultural change. But justice is incomplete if it stops at a law prohibiting FGM. Governments, donors, and institutions must recognize survivor rehabilitation as an essential pillar of anti-FGM work.

Equality Now’s campaigning makes this clear: the fight against FGM does not end when the law is passed; it continues until survivors are supported, informed, and able to heal on their own terms. Reconstructive surgery may be part of that journey for some women. Ensuring it is safe, ethical, accessible, and never compulsory is a shared responsibility, one that demands political will, public investment, and sustained philanthropic commitment.