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: Misleading use of FGM statistics compounds concerns about their reliability

Saffron Karlsen and colleagues raise concerns about the quality of FGM statistics.1 Unfortunately, their limitations are compounded by the misleading ways in which the statistics are used to support public claims of high rates of prevalence of FGM among girls. In addition, the statistics are sometimes misquoted in criticisms that refute the public claims.

Even the otherwise excellent editorial wrongly stated, “Girls are considered at risk if born to a mother who has FGM. Estimates based on migration data suggest there are up to 60,000 such girls in the UK.”2 Our report, based on birth registration statistics, estimated that from 1996 to 2010, 60,273 girls were born in England and Wales to migrant mothers with FGM and a further 17,344 were born in the years 2011-13.3

We went on to say that “Our earlier report attempted to assess the numbers of girls born in England and Wales who could be described as being ‘at risk’. This is no longer appropriate. On the one hand, qualitative research has shown that attitudes to FGM have changed on migration and in response to community-based programmes and many families have abandoned it while on the other, there are still reports of girls living in England and Wales being subjected to FGM or threatened with it. In neither case, has the extent been quantified in a way which can be used in numerical estimates at a population level. Risks to girls have to be assessed through contacts with individual mothers and families.”3 This informed warning that quantification is not possible has been widely ignored.

The FGM enhanced dataset for England has little to recommend it, as the editorial makes clear.2 On the positive side, the team responsible for the data publishes reports which explain clearly what is recorded.4 Unfortunately, it appears that these are not widely read by people who use the data to claim that FGM is widespread. The reports include numerous prominent warnings about the poor quality and incompleteness of the data and are accompanied by a separate data quality reports.5 One item which is fully reported is the woman’s age at attendance. In the most recent annual report, only 70 ( 1.1%) of the 6,195 women and girls reported as attending In the financial year 2017-18 were aged under 18.6 This may be an overestimate as some babies born to women with FGM may have been included, despite instructions to the contrary.6

There is no routine system for monitoring or assessing the mandatory reporting to the police of girls under 18 suspected of having undergone FGM at any time in their lives, including before arrival in the UK, or the outcome of the reporting. This is a major gap. The Ministry of Justice collects and publishes data about applications for Female Genital Mutilation Protection Orders in England and Wales. From June 2015 to September 2018, 292 applications had been made for these orders and 181 had been dealt with.7

The Department for Education’s Statistics on ‘Children in need’ include up to five factors mentioned for each child assessed by social services. In the year ending March 2018, abuse or neglect was the ‘primary need’ for 53.2% of these children referred. Domestic violence was mentioned as an ‘additional need’ for 51.1% of children and mental health for 42.6%, while children for whom FGM was mentioned accounted for only 0.2%. A mention of FGM could mean a child may have been directly threatened with FGM. Alternatively, a child may have been born elsewhere but underwent it before arriving in England or taken abroad for FGM or reported just because of having been born to a mother with FGM. An apparent doubling of numbers was reported in the BMJ and the national press, but after a suspiciously large number in just one local authority was queried, this was traced to a coding error. The Department then issued corrected figures which showed a fall from 970 mentions in the year ending March 2017 to 940 in the year ending March 2018.8,9

As mentioned in the editorial, the interim findings of a study by the British Paediatric Surveillance Unit found only 61 ‘confirmed cases’ of FGM among those notified in a two year period.10

Essentially, all these data compiled at a population level point to very low numbers of girls living in countries of the UK who have undergone FGM, either recently or in the past, especially among girls born in the UK. Data published by voluntary organisations involved with work on FGM also show a low level of activity. The NSPCC, which established a helpline in June 2013, reported dealing with 2102 contacts in the period 24 June 2013 to 31 January 2018, 22% of which led to referrals to external agencies.11

The National FGM Centre, a partnership between Barnardo’s and the Local Government Association, reported that it had 390 case referrals between Sept 2015 and December 2018 from local authorities in East England and London and 14 from other local authorities in England and Wales. It had supported the application of 23 FGM Protection Orders over this time.12
Although these data are somewhat piecemeal, taken together they do not support claims that FGM is widespread among girls born in England and Wales to mothers from FGM-practising countries. At most, they suggest that a few girls are still subjected to FGM, but that their numbers are low.

References
1 Karlsen S, Mogilnicka M, Carver N, Pantazis C. Empirical evidence supports concerns about reliability of FGM statistics and negative impact of FGM-safeguarding. Rapid Reponse BMJ 11 January 2019. https://www.bmj.com/content/364/bmj.l15/rr.

2 Creighton SM, Samuel Z, Otoo-Oyortey N, Hodes D (2019) Tackling female genital mutilation in the UK: Current response is disproportionate and should be reconsidered BMJ 2019;364:l15

3 Macfarlane A, Dorkenoo E. Prevalence of Female Genital Mutilation in England and Wales: National and local estimates. London: City University London and Equality Now, 2015. http://openaccess.city.ac.uk/12382/

4 NHS Digital. Female genital mutilation (FGM) statistics. https://data.gov.uk/dataset/af6155a5-1e2c-4d7d-85eb-4f9b1c3835a5/female-...

5 NHS Digital. Female Genital Mutilation (FGM) Enhanced Dataset, Data Quality Statement Experimental Statistics. https://files.digital.nhs.uk/2B/178473/FGM%202018%20AR%20-%20Data%20Qual...

6 Female Genital Mutilation (FGM) Enhanced Dataset April 2017 to March 2018, England, experimental statistics, Annual Report. https://files.digital.nhs.uk/B5/11CDB9/FGM%202018%20AR%20-%20Report.pdf

7 Ministry of Justice. Family Court Statistics Quarterly: July to September 2018. Family Court Tables. Table 19. https://www.gov.uk/government/statistics/family-court-statistics-quarter...

8 https://www.gov.uk/government/statistics/characteristics-of-children-in-...

9 Macfarlane A. Re: Seven days in medicine: 28 November to 4 December 2018: Corrected figures show that numbers of reports of FGM have decreased rather than doubling .Rapid Response BMJ December 12 2018. https://www.bmj.com/content/363/bmj.k5126/rapid-responses.

10 Ayadi O’Donnell N, Leoni M, Debelle G, et al. Female genital mutilation surveillance in under 16 year olds in the UK and Ireland. Arch Dis Child2018;103(suppl 1): A201. doi:10.1136/archdischild-2018-rcpch.138.

11 www://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/female-genital... Accessed February 6 2019.

12 National FGM Centre. Our vision and aims. http://nationalfgmcentre.org.uk/about-us/Accessed. February 6 2019.

Email: A.J.Macfarlane@city.ac.uk

Competing interests: No competing interests

07 February 2019
Alison J Macfarlane
Professor of Perinatal Health
City, University of London
Centre for Maternal and Child Health Research,