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First UK prosecution for female genital mutilation raises concerns among doctors

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2424 (Published 28 March 2014) Cite this as: BMJ 2014;348:g2424
  1. Clare Dyer
  1. 1BMJ

Obstetricians have said that the first prosecution for female genital mutilation (FGM) in the United Kingdom could lead doctors to fear criminal charges if they carry out repairs to stop post-birth bleeding in women who have previously been subjected to the illegal procedure, which has been a specific crime in the UK since 1985.

The first prosecution for the offence has been launched against a doctor who, the Crown Prosecution Service alleges, “repaired FGM that had previously been performed on the patient, allegedly carrying out FGM himself,”1 after a patient had given birth.

One senior gynaecologist called into question the timing of the Crown Prosecution Service’s announcement, which came just days before the director of public prosecutions, Alison Saunders, was due to appear before the House of Commons’ home affairs committee inquiry into FGM. Katrina Erskine, head of obstetrics at Homerton Hospital in London, said in an interview with the Independent newspaper, “I cannot help suspecting this has something to do with the [director of public prosecutions] being up before the home affairs select committee and she needs something to say.”2

Saunders appeared before the committee on 25 March and was asked the reason for the “sudden” announcement. She replied, “The fact that we’ve had the evidence that’s been supplied to us that’s enabled us to bring a prosecution, it’s as simple as that.”

She added, “We have been for some time proactively working with the police to try and get to the stage where we could bring a prosecution but you can’t bring a prosecution unless you have the evidence and we haven’t been able to until this case was referred to us.” She said that the Crown Prosecution Service had taken decisions so far in five of the 11 cases referred “in the last two or three years” and had decided against prosecuting in four cases.

Dhanuson Dharmasena, a registrar in obstetrics and gynaecology at the Whittington Hospital in north London, faces charges along with Hasan Mohamed, who is not a doctor and is charged with encouraging the doctor and aiding and abetting the offence.

Peter Brocklehurst, director of the institute of women’s health at University College London, told the BMJ, “I don’t know any details about the case apart from what’s out in the public domain. It may be that this woman has had FGM when she was either a child or a young woman and then has presented in labour without any surgery being done to reverse the FGM during the pregnancy.”

In such circumstances, treating the tearing that can result from childbirth may in some cases mean that the surgeon is left with few options, he said.

Brocklehurst said that it would be much more “clear cut” to prosecute somebody who had subjected a child to FGM. He said, “My concern is that the uncertainty around the detail of this case will make obstetricians and midwives at the moment very nervous about what they should do in these situations. To feel that whatever they do they could potentially be liable for prosecution will make them very insecure and anxious about giving appropriate care at the time of birth.

“If a woman in a similar situation who has had FGM and who has not had any repair during the pregnancy is admitted in labour, consultants are going to be called in left, right, and centre to do the repairs.”

Saunders told the committee that there was no use in waiting for “the archetypal young girl” to come through the door who was willing to give evidence against her family. In one case where it had been decided not to prosecute, the victim was very clear that she did not want to come to court, and there was a question about her mental health if she did.

Saunders said that more “intelligence led investigations” were needed and that she had written to ministers last month urging them to make it mandatory for healthcare and other professionals to report evidence of FGM to the police.

She also expressed support for a change in the law to make parents responsible for protecting their children from FGM and making it illegal for them to permit their daughters to be cut.

Notes

Cite this as: BMJ 2014;348:g2424

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