Articles on Shifting Sands
Adult genital piercings are still reported as FGM
Contrary to popular opinion, women who’ve had genital piercings, voluntarily, as adults, in the UK, are reported by the NHS to have undergone FGM.
Eight years of data in regard to women and girls who have had FGM and were seen in NHS services in England, has recently been published in summary.
Since data collection for NHS England began in April 2015 via an FGM Prevalence Dataset, then an Enhanced one, the practice was relevant to the attendance of 33,590 women and girls up to the end of March 2023.
We are told that information may be missing for many reasons e.g. the women and girls may not have wanted to answer questions that may be very personal to them. But where information is know, the majority were under 18 years old at the time they underwent the practice.
In most instances, we are told there is a long gap between when the FGM was undertaken to when information about it was collected by the NHS. That’s because it is mostly seen when adults attend an NHS maternity or obstetric service.
- The age when FGM was undertaken is known for only 39.2 per cent of attendees
- The treatment function area is known for 78.9 per cent of them
- The geographical area where FGM was undertaken is known for only 43.3 per cent
- Only the age when first seen in the NHS is known for all.
We learn from ALL of the key information about the cases collected over the eight year period that:
- 545 women and girls had undergone FGM in the UK
- Of these, 90.9 per cent had genital piercings as an adult
- Only 9.1 per cent had a type that was not a genital piercing OR that took place when they were a child
It may surprise readers to learn that genital piercings in adults, although not illegal, continue to be described as FGM (Type IV).
I reported in 2017 that the majority of FGM being undertaken in the UK were genital piercings. And that these were mostly labial, vaginal entry and clitoral.
I also reported in 2019 that caucasian females, including pregnant under 18’s, who have had genital piercings were being included in the FGM data, although few believe that undergoing this practice voluntarily should be considered FGM.
In 2019, a letter sent to Executive Leads for Safeguarding from FGM Leads in NHS England, the National Police Chief Council and the Crown Prosecution Service advised that genital piercings, practiced on consenting adult women, do not raise safeguarding concerns and do not need to be reported to the Police.
Specifically, the letter advised that piercing female genitalia – “to adorn it with jewellery or other accessories purely for the purpose of personal decoration or in order to enhance the sensation of sexual contact” – will not usually amount to FGM.
However, because the World Health Organisation classifies any genital piercing (on adults or children) as Type IV FGM, NHS Trusts and GP Practices must reflect the WHO’s classification when recording genital piercing cases on the FGM Dataset. The 90.9 per cent reflect this.
More detailed information is not provided in regard to the 9.1 per cent. However, as there was just one prosecution leading to a (questionable) conviction during that eight years time frame, it is possible that other Types reported were ‘unknown’ or may have been other Type IV’s like clitoral hood pricking or labial stretching.
Or, as is highly likely, the person may have been subjected to a Type before immigrating.
Importantly we are reminded ‘(A)s so much detail about the women and girls’ FGM is not known, any conclusions based on this information should be considered very carefully.’
Unfortunately, that advice is rarely taken when sensationalism is what’s required.
How this information is obtained
Clinicians working across healthcare settings were mandated in a 2015 Directive, signed by the then Parliamentary Under-Secretary of State for Public Health, to collect and centralise patient identifiable FGM data. Acute hospital and mental health providers as well as GP practices had to submit data first to a Prevalence Dataset, then an FGM Enhanced Dataset (SCCI 2026 Information Standards Notice). Uniquely, patient consent was not, and continues not to be the basis for centralising and processing this personalised and sensitive data.
During those eight years, FGM attendance records were submitted from 149 NHS trusts and 257 GP practices. Submitting this data was unpopular with many health professionals, some of whom opposed the mandate from the outset. It is unsurprising that the numbers submitting data fell over time. In the most recent reporting period, January to March 2023, only 82 NHS trusts and 21 GP practices submitted one or more FGM attendance record.
Despite the many concerns and criticisms (e.g. here and here) of the FGM Datasets, NHS England and the Department of Health and Social Care still consider it ‘a valuable information source supporting the identification, commissioning and management of FGM services both nationally and locally.’ They are however now planning to review its content and the processes surrounding it, and intend launching a long awaited/deferred consultation ‘to help improve its quality and completeness’.
Let’s hope they will consider this an opportunity to:
- respect women’s autonomy and stop reporting adults who’ve voluntarily undergone genital cosmetic surgeries as having had FGM
- reconsider the value of adhering to outdated and inaccurate WHO FGM classifications
- review the NHS justification for its double standards in centralising confidential, named patient data without consent
Anybody wanting to be contacted directly when this consultation is released is asked to email [email protected] and include the text ‘Consultation notification request’ in the subject line. We look forward to receiving it.
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.