Intended for healthcare professionals

Editorials

Tackling female genital mutilation in the UK

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l15 (Published 07 January 2019) Cite this as: BMJ 2019;364:l15

Re: Tackling female genital mutilation in the UK

These leading figures in health, legal and advocacy work in and around FGM are to be congratulated for a carefully considered appraisal of measures to tackle FGM in the UK (1). Despite what sensationalist media headlines may cry out, Creighton and colleagues discuss what has hitherto been unmentionable: there is no evidence that large numbers of girls living in UK are having FGM. They do not diminish the need to protect those girls at risk but instead call for a proportionate response. The authors also articulate wider and growing concerns of many frontline health and social care professionals and grassroots communities (2). But what will it take for policy makers to act?
However well-intentioned legislative measures such as mandatory reporting of under 18s and the Enhanced Dataset were, there have been numerous unintended consequences which policy makers are reluctant to hear. The mandated disclosure of FGM in a health consultation demands a breach of patient confidentiality without consent. Communities report loss of trust in the doctor–patient relationship and have indicated that women and girls with FGM are deterred from seeking help for complications, or even engaging with health professionals on unrelated matters (3). With mandatory reporting, benefit over and above existing safeguarding procedures have yet to be demonstrated. Numerous well-founded concerns raised during the consultation process of the latest initiative, the FGM Information Sharing system by both professional and community groups have been ignored. The potential fall-out from humiliation and alienation of already hard-to-reach communities should not be underestimated.
The current response is disproportionate and costly and with the balance tipped towards harm, unethical. It is time to reconsider strategy and for proper engagement with both professionals and communities to arrive at workable and appropriate solutions.
(1) Tackling female genital mutilation in the UK. Creighton, S et al., BMJ;364:136
(2) The narrative around FGM needs to move beyond prosecution. Kelly B & Ali, F (2018)
https://blogs.bmj.com/bmj/2018/02/15/brenda-kelly-and-filsan-ali-the-nar...
(3) The prevention of female genital mutilation in England: what can be done? Plugge, E et al. Journal of Public Health 2018| pp. 1–6 https://doi.org/10.1093/pubmed/fdy128

Competing interests: No competing interests

25 January 2019
Brenda A Kelly
Consultant Obstetrician and Clinical Lead of the Oxford Rose Clinic
Oxford University Hospitals NHS Foundation Trust
John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU