UK’s shameful record on female genital mutilationBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8121 (Published 03 December 2012) Cite this as: BMJ 2012;345:e8121
Ayanna, a 23 year old mother now living on the 15th floor of a Glasgow tower block, fled Gambia a year ago and applied for asylum in the UK to escape an abusive husband and prevent her 6 month old baby girl from being genitally mutilated. “My husband would have insisted,” she explains. “All the women in my community have been cut.”
She says she feels safe in Scotland but tries to avoid contact with the African community. “They’ll tell me that my daughter should be cut. It’s being done here,” she says, pointing through the window at the other tower blocks which make up the Red Road housing estate. “The older women do it—the grandmothers,” she explains. “They use scissors, razor blades, or sharp knives. I know that just last week one 3 year old and a 2 week old baby were cut.”
A group of Somali schoolgirls in Bristol tell me of “cutting parties.” “They tell you that something exciting is going to happen at the party, something that will make us adults. Parents organise the party because it is cheaper that way,” explains 18 year old Mouna. Who does the cutting? “They get an older woman, or the local Imam. Someone with experience who knows how to do it.”
The cutting normally involves what the World Health Organization categorises as type 3 mutilation, says Comfort Momoh, a midwife at St Thomas’ Hospital in London who is widely regarded as the UK expert on the subject. “The clitoris is removed, the vaginal area is sewn up, only leaving a small hole through which the woman can urinate and menstruate. Sexual intercourse is very painful.” That could be putting it mildly. Ayanna told me that, for her, sexual intercourse is more painful than childbirth.
Why is it still happening in the UK despite the fact that the practice was banned in 1985? A report compiled by the female genital mutilation (FGM) campaigning group, Forward, together with the London School of Hygiene claims that some 20 000 young girls are at risk each year.1 Momoh says that there are now 17 specialised units in NHS hospitals in England set up to cope with the number of immigrant women who arrive at hospital, often in an advanced state of labour, who have to be defibulated to allow for childbirth. There is little doubt that this ghastly, criminal practice is taking place routinely in the UK and yet no one has ever been prosecuted for it.
Across the Channel, in France where female genital mutilation was outlawed at about the same time as in the UK, there have been more than 40 high profile trials. Over 100 parents and two practitioners have been convicted and served prison sentences. “In England, you don’t want to hurt the feelings of immigrants or of people of foreign origin,” says campaigning lawyer, Linda Weil-Curial. “But, what is more important—these people’s feelings or the suffering of their children?”
Weil-Curial is contemptuous of the British attitude. “In France we believe that society must look after the child. In the UK, I have never heard that anyone has had the guts to report that a little girl has been cut. Why? That is the wonder.”
Linda introduced me to one of France’s most infamous practitioners of FGM, Hawa Greou, who is originally from Mali. Now in her 70s, she was jailed for eight years in 1999 for mutilating 48 girls. She was reported when neighbours complained to police about the repeated screams of anguish that were heard coming from her apartment. The police charged Greou and, at the subsequent trial, Weil-Curial represented the children. She and Greou, now out of jail, have become good friends and campaign together against FGM. “The lawyers did what they had to do,” says Greou today, “they had to send me to prison. They did their job.”
The trial was played out on French television night after night and sent a clear message to the immigrant communities of France. But the campaign against FGM is also being fought in clinics and schools throughout the country. All French mothers are expected to attend mother and child clinics for regular check-ups until a child is 6 years old. Doctors and nurses have no inhibitions about examining the genitalia of little girls.
Such an examination would be considered an abuse of human rights in the UK, I explain to a doctor at one of the clinics on the outskirts of Paris, Malika Ameliou. “Why?” she asks, genuinely surprised at my remark. “We are here to protect all little girls, and the examinations are carried out on all ethnic groups. No one complains because it is in the interests of the child.”
Most mutilations are carried out under the age of 6. Nonetheless, Ameliou says that examinations continue on all girls of school age, when they are more deliberately targeted. “After 6 years old, we liaise with school health inspectors, who visit schools regularly so that they can check on girls and families considered most at risk. If we find a girl has been mutilated, we offer her medical and psychological support and also surgery, if she wants it.”
The French system is not just punitive against the offenders. Since 2004, hundreds of young women have been offered reconstructive surgery, paid for by the state and thanks to a pioneering urological surgeon at St Germain Poissy Hospital outside Paris, Pierre Foldes, who works pro bono on these cases. He has operated on nearly 3000 young women, and in most cases, he says, the procedure “has reduced local pain and restored clitoral pleasure.”
Turning a blind eye
So why can’t we be more like the French? When I asked the Department of Health press office whether there were any plans for offering reconstructive surgery in the UK, I was told there were none, apart from the defibulation necessary to ease sexual intercourse and childbirth. During my investigations, I heard of one doctor in Scotland who sewed a woman back up after childbirth because her husband told him that it was “our culture.”
I was unable to corroborate this story because so few people in official positions are prepared to talk. In Scotland, where mass immigration is relatively new, health workers told me off the record that they are struggling to cope. The Scottish NHS told me I could not interview doctors and midwives about FGM. When I asked Social Services whether their employees look out for baby girls born to mothers from communities that practise FGM, I was told there “were no social workers available with sufficient experience of FGM” who could answer my question.
Commander Simon Foy, the child abuse specialist at Scotland Yard, perhaps best sums up the British head in the sand attitude. When asked why there had been so few prosecutions, he replied, “I am not necessarily sure that the availability of a stronger sense of prosecution will change it for the better” and went on to explain how hard it is to investigate cases. When asked whether inspections might help, he replied, “Inspection almost at times is considered to be a form of abuse in itself. We should not encourage behaviour if that behaviour is in itself child abuse.”
I suspect that his view that inspections would be child abuse is widely held in the UK. But it is a scandal that so little has been done since we were alerted to the prevalence of FGM in the UK almost 30 years ago.
The Dutch, ever pragmatic and sensible in these matters, have come up with a good compromise, although it addresses only part of the problem. Many girls from European countries are cut while on long summer holidays in the countries of their parents’ origin. After consulting with local, immigrant groups, the Dutch government has produced a health passport, which is printed in every language relevant to Dutch immigrants. It contains a warning that if a child is cut while away, her parents will be arrested on their return to the Netherlands.
Zarah Naleie of the Federation of Somali Associations in the Netherlands, who was part of the Dutch government consultation process, says these passports have reduced the number of mutilations. She explains that families in Somalia are reliant on remittances sent back by family members living in the Netherlands and Britain. “It helps,” she says, “if a woman can go back home and say “if you mutilate my daughter, I’ll go to prison and I’ll no longer be able to help you financially.”
This idea was apparently under consideration at the UK Home Office but nothing has yet materialised. Naleie claims that thousands of Somalis have left the Netherlands to settle in the UK in recent years because “there are fewer controls there and less awareness about FGM. FGM is being carried out underground in the UK. People from many countries in Europe go to the UK for this purpose.”
So what are we in the UK doing? The Crown Prosecution Service has recently published action plans, I like to think partly because BBC2’s Newsnight commissioned a number of reports on FGM and devoted an entire programme to the subject in July. The director of public prosecutions, Keir Starmer, says that he is “determined to start getting these offenders to court.” In his list of “action plans,” he calls for the involvement of health workers in the following ways:
Explore what the reporting duties are for medical professionals, social care professionals, and teachers in referring possible FGM cases to the police
Consider whether existing reporting mechanisms need strengthening
Consider position of medical professionals to enable reporting without risk of criminalisation.
We shall see whether, as Weil-Curial would put it, we have “the guts” to implement the plans. Meanwhile, the latest figures published by Forward on the incidence of FGM in the UK suggest that, with the recent increase in the Somali population, the number of mutilations is increasing or, as one campaigner points out, two children in the UK could be being mutilated every hour.
Cite this as: BMJ 2012;345:e8121
Competing interests: The author has completed the ICMJE unified disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Commissioned; not externally peer reviewed.