A witch hunt will only drive FGM underground

FGM is declining globally. That’s probably not a headline you’ve ever read, but according to a 2013 UNICEF report, ‘the dangerous centuries-old tradition is now on a slow but steady decline in key areas around the world’. What great news that is.

There’s general agreement (from Barack Obama to David Cameron, from London’s Evening Standard to The Guardian) that ‘Something Must Be Done’. Tougher law enforcement is considered to be an important part of the answer, as well as surveillance, education and awareness-raising.

FGM was outlawed in the UK in 1985, and in 2003 it also became illegal to take a girl abroad for genital mutilation. It’s been reported that more than 3,000 cases of FGM have been treated in British hospitals since 2001, and that 70 women and girls aged as young as seven seek treatment every month.

The Department of Health estimates that 66,000 women in England and Wales are living with the consequences of FGM, and a further 23,000 girls under the age of 15 are at risk every year. But can we trust the accuracy of these figures from a 2007 study, when even by the authors’ own admissions the estimates presented are subject to several limitations? There’s never been a prosecution for FGM, although two people were arrested in 2013.

In contrast to the UK, France, with its large immigrant community of Muslims, carries out surveillance on high-risk families and prosecutes an average of three a year. Of the 100 people who have gone on trial for FGM in France since 1985, there have been 29 convictions.

A collaborative effort by bodies including the RCN, the Royal College of Obstetricians & Gynaecologists, the Royal College of Midwives and the Community Practitioners’ & Health Visitors’ Association led to the production of a report Tackling FGM in the UK in November 2013. In the introduction, Keir Starmer QC, the then director of public prosecutions, labels FGM a ‘barbaric’ procedure and calls for all women who have had the procedure to be identified so as to prevent their female children – potential future victims – from having to undergo the practice.

I first encountered FGM in the 1970s when I worked as a nurse/midwife in the contested Ogaden area of Ethiopia, inhabited predominantly by Somali-speaking Muslims. A four – seven year old girl was carried to our mobile clinic. She was semi-conscious and her clothes were saturated in blood. They told me she’d been ‘circumcised’ that morning. The elderly woman who circumcised girls had used the usual razor blade but something had gone wrong and the girl wouldn’t stop bleeding. What could I do?

Well, to be honest, not much. It was way too late for her, bearing in mind the conditions we worked in and the facilities available. I gave her intravenous fluids – we couldn’t do anything more sophisticated. She died. I was shocked. Her family were distraught. They cried and wailed as they carried her small, dead body away for burial.

When I saw the ‘circumciser’ again we discussed the death and the practice via an interpreter. I made her promise that she would never again carry out circumcisions. She agreed and I felt better. But deep down I knew that she wasn’t convinced and that she’d continue the practice. I’d grown to understand, if not accept, that the need for girls to be circumcised was a deeply held belief. That child’s death, terrible as it was, wouldn’t stop it.

Although I didn’t see any more children with complications (maybe families avoided bringing them to the clinic), I subsequently delivered circumcised women in Ethiopia. But because they’d ‘only’ had their clitoris removed, they didn’t experience problems when giving birth. I knew, depending on the extent of the cutting, that some women could experience quite severe problems.

Since then I have worked in London with women colleagues who were ‘cut’ to varying degrees when they were children, some of whom had subsequently become campaigners against the practice within their communities here.

It’s so easy to take the moral high ground: to assume we should save children from their parents’ and communities’ ‘barbaric’, ‘abhorrent’ and ‘mutilating’ practices. Who could possibly be in favour of FGM and putting young girls through such an experience? A practice that leaves many with long-term complications and the likelihood of an unfulfilled sexual and emotional life?

But despite all this, I can’t buy into demands that ‘cutters’ should be reported, testified against or prosecuted. Or that screening of potential girl victims should become NHS practice. And that’s not because I’m a cultural relativist or think FGM acceptable. I don’t. But I understand, as the Eritrean woman Tsedal Tesfamariam wrote, that ‘FGM is a deeply personal and private issue in which a greater understanding of the wider cultural background to this practice is essential if we are going to have a serious discussion about bringing it to an end’.

Consequently, I think that the law is too blunt an instrument for dealing with the problem. FGM may technically be abusive, but that’s not how it’s viewed within communities who practise it. They love their children and are doing what they think is right for them – just like we do.

How widespread is this practice? France’s conviction rate of three cases per year hardly suggests an epidemic. And as we’ve learned, FGM has been dying out among immigrant communities there in recent generations. Okay, so that could be to do with France’s surveillance programme and the fact that it prosecutes. But FGM is also declining in the countries of origin. Can we be so sure that the same thing is not happening here in Britain? It’d be surprising if it wasn’t.

Our government has instructed hospitals to log information and record details of the wounds of each victim they see on their hospital database. The number of women who have been treated by the NHS for FGM will be available. Girls ‘at risk’ will be identifiable if they have a mother, sister or member of their extended family who has been subjected to FGM.

Meanwhile, according to the Sunday Times, ‘sympathetic doctors who prescribe pain relief to victims, travel agents who arrange flights to countries where the cutting takes place and money lenders who provide finance for families to arrange it, will all be targeted’.

It’s not difficult to imagine the scenario of what might happen when this system is introduced. It’s normal practice now for the background history of every child who attends an A&E department to be checked, to identify whether they are on the child protection register or have been  subject to a non-accidental injury. This makes parents anxious and some think twice about taking their child to A&E for fear of the injury being misinterpreted as non-accidental. People who don’t want their family scrutinised for actual or potential FGM may understandably give A&E a wide berth as well.

And if they are continuously being told that the practice they perpetrate on their children is barbaric and cruel, how are they to interpret the way they are viewed by British society? Cruel, barbarous mutilators? Not exactly something you’d voluntarily subject yourself to, is it?

As Tsedal Tesfamariam said: ‘The “end-FGM” campaigning lacks the capacity to engage communities and to challenge in any meaningful way the problem of FGM. Instead, it indulges in finger-pointing and scaremongering about the practices of these communities. It fails to acknowledge the various efforts being made to halt FGM within many communities, and it calls into question people’s capacity to change without the guidance – and laws – of outsiders.’

So my suggestion is that, in the interest of our common humanity, we leave the issue alone. The practice is already illegal. I’m pretty sure that every African, Asian and Middle Eastern community in the UK is well aware of this already. Pursuing a witch hunt against perpetrators and facilitators will only drive it underground. And there’s evidence that FGM is on the decline. Any additional information deemed necessary can be passed to the families sensitively by healthcare professionals. Prosecuting and name calling is insensitive.

This was initially published as an opinion piece by RCN1 Feb 2014 but is accessible to subscribers only.  It can also be accessed here.