Articles on Shifting Sands
Time to decriminalise FGM and end funding the industry
Barnardo’s Children’s Charity and the Local Government Association who jointly run The National FGM Centre, seem happiest when FGM data is obscured in and by the media. They have even used COVID-19 related home seclusions to exaggerate the danger this presents to children from specific families. I believe it’s time to question the need for the FGM industry and to decriminalise the practice.
When NHS Digital publishes unremarkable FGM reports (as they did again for the period from January to March 2020), the organisations try to generate publicity by sending press releases to regional newspapers, highlighting the FGM incidence in their area. In this quarter they also included content which sows suspicion about specific families’ intent in regard to their children’s safety, as well as suggesting that professionals might be ignoring those potentially ‘at risk’ of FGM. The press releases are then dutifully published almost verbatim, generating the desired oxygen of publicity for the organisations, while stigmatising and sowing suspicion of particular people about what has become a diminishing practice in the UK.
You may wonder why they remain fixated on reporting the incidence and prevalence of the practice when the only type of ‘FGM’ occuring in the UK is genital piercings. Or why the number of women and girls being seen in NHS who’ve undergone historic FGM remains of public interest? Genital surgeries such as labiaplasty (controversial to some) are not reported like this. But so all pervasive is the alarmist and inaccurate FGM narrative, of FGM being practiced covertly and female children at risk of it from their families, press reports with scary headlines remain acceptable.
Why is FGM reported?
Since April 2015, NHS Digital has supported the Department of Health and Social Care’s FGM Prevention Programme by reporting the prevalence of FGM in England’s NHS. Different systems operate in Wales, Scotland and Northern Ireland. Data in England is collected by acute hospitals, mental health services and GP practices and then centralised to an FGM Enhanced Dataset.
Before the reporting system was initiated in 2015, a City University report by Professor of Perinatal Health, Alison Macfarlane, and Efua Dorkeeno had estimated that in 2011 approximately 137,000 women born in the countries where FGM was practised and living in England and Wales, had undergone FGM.
The authors could not however estimate the numbers of women and girls born in England and Wales who had undergone FGM.
Nor could they assess the numbers ‘at risk’ of FGM, saying “(i)t is important ……not to assume that their daughters are all at risk, as many families have given up FGM on migration and attitudes have changed in some of their countries of origin. On the other hand, others may have not given up FGM and it is important to safeguard their daughters.” A raft of safeguarding measures were introduced from 2015 onwards.
Despite that Professor Macfarlane has warned that quantification was not possible, the NHS continues to report an estimated 65,000 girls are ‘at risk’ in the UK. And even highlights the signs professionals should be alert to. Ironically the first is ‘knowing that a mother or older sibling has undergone FGM’.
She had also advised that the scale of the practice had been over-estimated and that “Risks to girls have to be assessed through contacts with individual mothers and families.” A generic ‘at risk’ category should therefore not be used in regard to FGM.
NHS FGM Reports
Since 2015, NHS trusts and GP practices in England have centralised data to NHS Digital which then compiles it and reports quarterly and annually. Reports always include the caveat that not all data fields are complete. Where data has a low level of completeness it is less reliable as the information presented is based on a smaller amount of the overall data. This caveat is mostly ignored in media reports. As are the specific concerns that clinicians and others have in regard to the collection and centralisation of this data which include patient confidentiality, identifiable data, consent and ‘slippery slope’ fears.
Since 2015, about 24,375 individual women and girls have had FGM identified for the first time in the NHS and around 85 per cent were in Midwifery and Obstetric services. Most had undergone the procedure prior to coming to the UK. This is a far cry from the “tip of the iceberg” prediction. Yet ‘experts’ like to report the real incidence is likely to be much higher, because it is largely a ‘hidden crime’.
Between January and March 2020, 860 women and girls were newly recorded on the NHS Database, and the average age at attendance was 32 years. Numbers have reduced over time and this is the lowest quarterly new number ever reported. NHS Digital explains that this is to be expected “as the longer the collection continues, the greater the chance of a women or girl having been recorded in it previously.” This reporting period also coincided with a time of increased pressure on NHS services as a result of the coronavirus (COVID-19).
Importantly, for those where FGM was undertaken under the age of 18, in 98 per cent of cases it occurred at least 10 years ago; 82 per cent of women and girls were born and had FGM undertaken in an African country; 86 per cent of ‘FGM’ undertaken in the UK remain piercings. We know anecdotally that this Type 4 (WHO classification) is being identified in pregnant, white, cuacasian teens. The remainder are often unknown/uncalssified.
In June, based on the press releases, a number of local newspapers dutifully published reports with alarmist headlines. They implied these cases were new instances of FGM. It’s understandable that the public is confused as to the real extent of FGM in the UK.
Sheffield wrote “Dozens of new FGM victims identified in Sheffield”. Bradford reported Figures show ‘at least 10’ FGM victims identified in the surrounding areas of Bradford; Peterborough: “20 female genital mutilation victims identified in Cambridgeshire and Peterborough in just three months”; East Berkshire: “New victims of FGM seen by the NHS in East Berkshire at the start of the year”; Southampton: “New female genital mutilation victims identified in Southampton”; Yorkshire: “Horrifying figures reveal extent of female genital mutilation victims in Yorkshire.”
To make the situation appear even more serious, the press releases raised the stakes by warning the risk to children and young people may have increased during the coronavirus lockdown because school closures reduce contact with teachers and health professionals. It took a leaf from the book of those who popularise that crises could lead to spikes in FGM around the world.
Mistrust families, blame health professionals
The Head of the National FGM Centre provided a quote for the press release promoting suspicion of families: ”While children and young people are at home, they are not linked to professionals and there are no services in contact with them – if there is a concern we wouldn’t know.” And “(t)hey don’t have those opportunities to hear concerns and respond to disclosure.”
He also pointed a finger at health professionals, suggesting “that vital questions which could identify someone as a FGM victim may also be going unasked during health visits, leaving women without the opportunity to seek support.” That “it is mandatory to record, but it is not mandatory to ask the question.” By implication, professionals are deliberately choosing not to consider FGM when they should, adopting instead a see no evil, hear no evil, report no evil maxim. That they may be turning a blind eye to something that is legally and morally wrong.
This follows the line the Metropolitan Police Service (MET) took in 2018, suggesting that professionals were naive in accepting people’s claims that they didn’t practice FGM any longer. That they were merely demonstrating ‘false compliance’, because the MET was certain FGM was continuing, and to ever younger girls.
The MET also wanted professionals who decided NFA (no further action) was necessary to become more professionally curious, to break the cycle of under-reporting and referral. Instead, they needed to share more information because the police relied on actionable intelligence to prosecute and convict.
I would like to suggest a number of ways forward:
The Government now needs to admit that the trajectory its pursuing in regard to FGM is unsuitable. The incidence is declining and new cases are not materialising. Even the much lauded single conviction probably represents a miscarriage of justice. People here have moved on even if the industry hasn’t. The practice needs to be decriminalised (GBH covers it) and depoliticised. Dealing with facts and the application of critical thinking would be a good place to start.
The state funded FGM industry (including DfID’s FGM work) is huge and the media should be asking critical questions instead of acting as its mouthpiece.
Data collected and published by NHS Digital is meaningless as well as undermining of patient’s rights to privacy. Unless the need for the collection of data of this nature, in this way, can be objectively justified, it should be discontinued.
Post COVID-19, money saving opportunities will no doubt be sought. The FGM industry which seeks to undermine, sow suspicion and cast asperions about particular people should have their funding withdrawn, and the resources put to better use.
Meanwhile Barnardo’s, the Local Government Association and the rest of the industry could more usefully challenge the COVID-19 related school closure fiasco and campaign for children to return to the normality of continuing their education, now.
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.
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