Articles on Shifting Sands
NHS FGM Prevention Programme needs evaluating
The Department of Health and NHS England’s FGM Prevention Programme urgently needs evaluating with a view to scaling it back or even discontinuing it. That’s because the FGM epidemic that we were told to expect hasn’t materialised. Nor is it likely to. But the Programme has caused a lot of damage.
Newly published NHS FGM data supports my contention. Contrary to what had become established practice in regard to the data, recent reports have gone almost unreported, including that of May 2019.
Not long ago sensationalist headlines were commonplace. The Independent for example reported ‘FGM case reported in England every 109 minutes’, Barnardo’s ‘eleven newly recorded cases in England every day’. And ‘experts’ regularly warned that any data was likely to be ‘tip of the iceberg‘.
The lack of coverage may be because commentators would have to admit that their previous hype was unwarranted. Any anyway good news doesn’t sell.
An aspect that hasn’t changed however is calls to continue or increase funding to what has effectively become a lucrative gravy-train. While the damage caused to targeted communities continues.
Fewer women/girls are presenting with FGM
The downward trend demonstrated by the published data indicates that the predicted FGM epidemic isn’t materialising. This is unsurprising to some of us because it’s been recognised for some time, and by experts like Professor Johnsdotter in particular, that migration results in broad opposition to FGM among concerned migrant groups in western countries.
Even in countries like Somalia where many of Britain’s immigrants who’ve undergone FGM originated, the prevalence rate has been estimated at 98 per cent for many years. But recent evidence from an observational study published in BMJ Global Health (2018) suggests huge falls in FGM/C among African girls aged 0-14 years. And the decline among children aged 0–14 years old was highest in East Africa.
In June 2016 I wrote in regard to the situation in the UK, ‘the FGM reality doesn’t live up to the scaremongering’.
I exposed then also that behind the sensationalist headlines an entirely different picture to the official one was emerging. For example when seven under-18s were reported to have undergone FGM in the UK, it became apparent that one of the seven had FGM of ‘an unknown type’. The other six had cosmetic genital piercings. Yes, genital piercings were being reported as FGM. And continue to be.
Why are genital piercings included?
The official explanation is: “While adult women may choose to have genital piercings, in some communities girls are forced to have them. The World Health Organisation currently defines all female genital piercings as a form of FGM. The data item FGM Type 4 Qualifier allows users to specify that the FGM was a piercing. Genital piercings are classed as FGM Type 4 – Piercing.”
But anecdotally, we know that the ‘FGM’ carried out on under 18’s in the UK is predominantly on pregnant, caucasian teens. Which means that ‘FGM’ is not happening to the ‘usual suspects’.
Yet many continue to cite the Government’s initial estimates of 20,000 girls under the age of 15 at risk of FGM in the UK each year, 6,000 in London alone, to help justify the Intervention Programme.
The reality is very different however. Just one girl has undergone FGM in the UK. The mother was found guilty in 2019. But there are serious concerns about that verdict and an appeal is sought.
And according to Professor of Perinatal Health, Alison Macfarlane, the scale of the practice has continually been over-estimated.
Since 2015, when data was first collected in the current format, 20,440 new individuals with FGM were seen and recorded in England’s NHS. This refers to patients where FGM was identified or a procedure for FGM was undertaken. Each patient is counted once only. Other countries employ different systems.
Between April 2018 – March 19, England’s NHS saw the lowest number of ‘newly recorded’ FGM patients ever in a year: 4,105. This is in contrast to the higher 4,495 seen during 2017-18, 5,391 during 2016 -17 and 5,700 during 2015-16.
During quarter 3 of 2018, the lowest number in any quarter was recorded – 985. Good news!
It is mandatory for acute hospital and mental health providers as well as GP practices to record and submit attendance records to the FGM Enhanced Database. During this reporting quarter, 88 NHS trusts and 26 GP practices did.
We aren’t told whether this is an acceptable or expected response. But anecdotally it is known that some health professionals/NHS Trusts have major concerns about the lack of patient confidentiality and are not returning the required data.
Only 1,015 women and girls were newly recorded in this reporting period. The average age was 32. Of these, where FGM was undertaken in under 18’s, it had occurred at least 10 years previously in 97 per cent of cases.
Where country of birth/country FGM was carried out was known, 86 per cent of women and girls were born and had FGM undertaken in an African country.
As has already been mentioned, the majority of cases undertaken in the UK are genital piercings. Some of the remaining may also be piercings but the submitted data is incomplete.
It’s also worth noting that newborn girls have been incorrectly recorded as having had FGM, and their inclusion will have helped inflate official figures, even if only slightly. NHS Digital wrote “When a woman with FGM has given birth to a baby girl, the baby should not be recorded in the dataset unless the baby girl has also been identified with FGM. We are aware that babies have been recorded in the dataset in error, and are working with the affected organisations to delete these records.”
I suspect that midwives felt under intense pressure to record newborns when the near hysteria about the FGM epidemic was tangible and professional guidance unclear. They had after all been told that if a mother had undergone FGM, her daughter would also.
It’s time to objectively review the Government’s FGM Prevention Programme.
People need to be given credit for choosing not to practice FGM in the UK. Whether and how much the law and campaigns have helped needs to be considered.
It has become apparent that the official response is disproportionate and the hype unwarranted. Many professionals with a working knowledge of the system do not have confidence in it. Future planned developments like the NHS-IS and RSE in schools should be reconsidered.
The review and evaluation should consider a repeal of the FGM laws. Grievous bodily harm, including mutilation, is already outlawed in the UK and has been a statutory offence for over 160 years. Why is there a need for specific FGM laws?
The role that the law and the Prevention Programme play in criminalising women and girls who happen to come from communities or countries where FGM is/was practiced should also be factored in. Many experience their application in practice as racist, discriminatory, harassing, stigmatising, alienating and ultimately detrimental to their inclusion into British society.
Women and girls who’ve undergone FGM should continue to have access to the sensitive care and support they need and deserve from public services.
Practitioners should take note of new research findings and use it to inform professional practice. They should also be allowed to use their professional judgement with cut pregnant women/mothers who say they have no intention of having their daughters cut, instead of automatically referring them to Social Services as too many do.
The review might also help identify how, where and to what effect public funds are being used. In July 2017, over £1.6 million was given to Barnardo’s to run the National FGM Centre for a further three years. Serious consideration should be given to the continued need for the Centre, the ubiquitous ‘awareness-raising’ programmes in schools by competing charities such as the NSPCC and FORWARD, as well as the industry that ‘community outreach’ has become.
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.