Articles on Shifting Sands
Still no UK FGM epidemic
Commentators often ask in bewilderment why nobody is being prosecuted for FGM in the UK. That’s because, in the popular imagination, the practice is alive and well here and the most severe form, infibulation, prevails.
Recent headlines will have contributed to reinforcing that outlook. For example The Guardian reported ‘NHS attended to 9,000 FGM cases in England last year’, and the BBC ‘FGM: More than 5,000 newly-recorded cases in England’. These appeared after the release of the latest NHS experimental statistics (annual report) of FGM. Predictably, sensationalism proved irresistible.
But as usual the devil is in the detail, and contrary to the headlines, the report actually contains good news. It confirms, once again, that nobody is being mutilated here. Unless you consider, as the WHO and British law does, that genital piercings are female genital mutilation.
The FGM Enhanced Dataset supports the Department of Health’s FGM Prevention Programme and in its latest report presented a picture of FGM prevalence for England. Different reporting systems operate in Scotland, Wales and Northern Ireland, making a UK-wide assessment impossible.
The report covers NHS attendances, predominantly in obstetric and gynaecological services, between April 2016 and March 2017.
It is mandatory for professionals working in healthcare organisations like acute hospital and mental health providers, as well as GP practices, to record specific FGM related data and then centralise it to NHS Digital.
But only 123 NHS trusts and 74 GP practices centralised the data. This is fewer than expected and only 20 more than last year. Low reporting could be because nobody attended services who had undergone or admitted to having undergone FGM.
But it may also be due of the disquiet that prevails among professionals about the inherent breach of confidentiality that the centralisation of this sensitive data represents. It unusually has to include patients names and addresses, sometimes without their consent. I have written about this here and here.
Data incompleteness was a problem in last years’ report which persists in this one, making useful comparisons between much of the data impossible. And totals do not always add up precisely.
We are told however that there were fewer (5,391) first time attendees in comparison with 6,080 the previous year, bringing the total over two years to 11,471. Total attendees amounted to 18,402; approximately nine thousand each year.
Considering the many immigrant women and girls from potentially affected immigrant communities living in England, this does not seem many. City University, in 2015, cited an estimated 137,000 women and girls with FGM, born in countries where FGM is practised, were permanently resident in England and Wales in 2011. The number is probably much higher now.
Despite that 87 per cent of the women and girls seen were born in an African country, and underwent the practice there, commentators interest lies predominantly with the UK situation. Many are no doubt remembering the predicted FGM epidemic. And media headlines probably feed into and promote this outlook which I’ve consistently challenged.
Unsurprisingly, 95 per cent of the women and girls seen had undergone FGM abroad and before they were 18 years old. Their average age when accessing NHS services was 31 years. But this information was recorded for only 33 per cent of attendees.
Country of birth
Although 5,391 women and girls attended for care, the answer to their country of birth was neither recorded, stated or was unknown for 2887; 53 per cent. That leaves us with an actual 2,504 with a known country of birth. Eastern Africa accounted for 1338; 54 per cent. The UK was rerecorded for 112 people.
Let’s turn out attention to these 112 women and girls. They represent just 4.5 percent of the 2,504 figure. That does not mean that they underwent FGM here, although some may have. Most, 55, were from the Midlands and East of England, followed by 25 from the north of England, 20 from the south of England and 15 from London.
Where was the FGM undertaken?
Only 26 per cent of all newly recorded women and girls had a country where FGM was undertaken, recorded. Fifty seven (57) underwent the practice in the UK. Of these, 50 had type 4 (88%). Types 1, 2, 3 and others are not recorded/are unknown and are represented by asterisks. So we can deduce that they amount to seven people (12 per cent).
What type of FGM had UK born undergone?
Professionals classify types according to the WHO and FGM laws although this is often an imprecise guide and identification can be difficult particularly when there are no visible signs. Ten of the 112 did not have a type recorded, leaving us with 102 who did. Of these, 85 (66%) had type 4, 10 (2%) type 1, and 5 (1%) type 2. ‘Type 3 and others’ are represented by an asterisk, meaning that 0 – 4 were identified. In this instance they amount to two. So it’s possible that two may have undergone infibulation. Or had no visible signs.
The report acknowledges ‘The majority of cases undertaken in the UK are known to be piercings.’ But because piercings are classified as type 4, they are viewed as genital mutilation. Hence the basis for those scary headlines.
At what age did they undergo FGM in the UK?
We are told that 45 of the 57 women were aged 18 or over when they had FGM. Ten did not have this data recorded, or it was unknown, thereby accounting for 55. That leaves just two under 17’s who had it in the UK. Yes, two. What was that about an epidemic?
On the basis of this albeit incomplete and imprecise data, it is patently obvious that there is no FGM epidemic in the UK. Nor are girls from potentially affected immigrant communities being mutilated. This means that there is nobody to prosecute.
Some questions spring to mind however. Is the ‘industry’ that has grown around FGM, and its associated infrastructure, warranted? Should the FGM Unit continue? This question has just been answered in the affirmative. The Department for Education has agreed to fund it up to 2020. Are the increased professional interventions in family life, the mandatory reporting, the additional laws, police reporting, FGM Protection Orders in addition to centralising this sensitive data really necessary? I don’t think so.
About the Author - Bríd Hehir
Bríd is a retired health professional. She started her career as a nurse and midwife in Africa where she worked for almost four years. She encountered FGM/C in Ethiopia. She then moved to London where she worked in the National Health Service as a midwife, community nurse, health visitor, reproductive and sexual health nurse and manager over a period of 30 years. She did not encounter FGM/C during that time despite working with immigrant communities who are reported to practice it still. She is puzzled by the current reported prevalence of the practice, the official response and associated activism. And is worried that they might cause more harm than good.