Female genital mutilation — structured SAQ (15 marks)

(a) Reproduce the WHO Type I-IV classification verbatim (5 marks)

One mark for the correct verbatim definition of each of Types I, II, III and IV, with subdivisions for I, II and III. ^[5][7]

• Type I. Partial or total removal of the clitoral glans and/or the prepuce/clitoral hood. Ia: removal of the prepuce/clitoral hood only. Ib: removal of the clitoral glans with the prepuce/clitoral hood.
• Type II. Partial or total removal of the clitoral glans and the labia minora, with or without removal of the labia majora. IIa: labia minora only. IIb: clitoral glans and labia minora. IIc: clitoral glans, labia minora and labia majora.
• Type III (infibulation). Narrowing of the vaginal opening with a covering seal formed by cutting and repositioning the labia minora or majora, with or without removal of the clitoral glans/prepuce. IIIa: repositioning of the labia minora. IIIb: repositioning of the labia majora.
• Type IV. All other harmful procedures for non-medical purposes — pricking, piercing, incising, scraping, cauterising.^[5][7]

(b) Antenatal and intrapartum plan for Type III (5 marks)

One mark per point. ^[2][5][8]

• Antenatal: confirm and document the WHO Type III finding in the handheld record and the hospital system; assess for urogenital and psychosexual complications; arrange a professional interpreter (non-family); offer female clinician and chaperone; mental-health screen.
• Deinfibulation plan: offer elective antenatal deinfibulation per current guidance as a day-case procedure under regional or general anaesthesia by a trained clinician, with consent including the explanation that reinfibulation will not be performed. If not done antenatally, plan deinfibulation at the onset of labour.
• Mode of birth: planned vaginal birth following deinfibulation. Reserve caesarean for standard obstetric indications or an unreadily-reversible Type III with obstruction at full dilation.
• Intrapartum vigilance: PPH preparedness (elevated risk); trained birth attendant; access to surgical backup; continuous support.
• Postpartum: never reinfibulate; offer psychosocial and sexual-health support; address contraception and the safeguarding of any daughter.^[2][5][8]

(c) ANZ legal framework and mandatory reporting (3 marks)

One mark per point. ^[8][9]

• FGM (performing or facilitating it, including 'vacation cutting' of a child abroad) is a criminal offence in every Australian state and territory and in New Zealand.
• A child at risk of FGM is a mandatory-reporting scenario — refer to child protection without delay.
• Reinfibulation is not offered — WHO recommends against it and reinfibulation is a form of FGM; document the refusal and the reasons given.^[5]

(d) Principles of culturally competent, trauma-informed care (2 marks)

One mark per point. ^[10][11]

• Female clinician and chaperone; privacy; trained professional (non-family) interpreter; non-judgmental language (use 'cutting' rather than 'mutilation' at the bedside; the practice is the problem, not the woman or her culture); explain every step of the examination and obtain consent for each.
• Continuity of care and community referral — specialist FGM services, community-led advocacy, peer support; recognise the examination may re-traumatise and be prepared to stop.^[10][11]