Impact of female genital mutilation laws, policies, and professional codes of conduct on healthcare workers' knowledge, attitudes, skills, and quality of care: A mixed‐method review

BACKGROUND: Over 230 million girls and women worldwide have undergone female genital mutilation (FGM), primarily in Africa, the Middle East, and parts of Asia. Although many countries have laws prohibiting FGM, enforcement remains a challenge. Efforts to eliminate FGM require a multifaceted approach, including policy implementation, community education, and training of healthcare workers (HCWs). OBJECTIVES: To explore how laws, policies, and professional codes of conduct related to FGM prevention and care affect HCWs' knowledge, attitudes, skills, and care delivery. SEARCH STRATEGY: A comprehensive search of the following electronic database was conducted: CINAHL Plus, IRIS, MEDLINE, PsycINFO, SCOPUS, and Web of Science. No language restrictions were applied in the literature search. SELECTION CRITERIA: Studies involving HCWs' perspectives or experiences with FGM laws and policies were included. Titles and abstracts were screened using Covidence, full texts were assessed for eligibility, and disagreements were resolved by a third reviewer. DATA COLLECTION AND ANALYSIS: All included studies were assessed for quality using an adapted version of the Critical Appraisal Skills Programme (CASP) tool. A thematic synthesis of the qualitative data was conducted, involving coding of the extracted data and performing thematic analysis. MAIN RESULTS: This review of 12 qualitative studies, from 2010 database records, identified six key themes regarding HCWs' experiences with FGM laws. HCWs often had limited knowledge of FGM laws, which impeded attitude changes toward FGM practices. Although some providers avoided performing medicalized FGM due to legal repercussions, others continued supporting or referring patients, because of cultural norms, religious beliefs, financial incentives, and weak enforcement. In addition, providers expressed discomfort with mandatory reporting and concerns about compromising patient trust. In some contexts, FGM laws were seen as contributing to health inequities by restricting culturally significant procedures while allowing similar or more invasive ones for others. The findings also revealed the emergence of modified FGM forms and significant gaps in providers' knowledge and communication skills when explaining legal prohibitions to affected girls and women. CONCLUSIONS: This review found no eligible quantitative studies. Qualitative findings reveal legal awareness alone does not change behavior. Therefore, comprehensive training, guidance on professional ethics, and stronger enforcement are needed to support HCWs in FGM prevention and response.