Acton’s FGM Clinic closure is good news

A petition aimed at stopping the imminent closure of Acton’s FGM Community Clinic is circulating. The clinic will close by April 2017 unless Ealing Clinical Commissioning Group reverse their decision not to invest in this service. To date, the petition has achieved 14,000+ signatures and attracted comments like:

‘Not to renew support for this clinic and yet to denounce FGM is pure hypocrisy on the part of government, local of national. We’re not short of hypocrisy; can we try a dose of humanity?’

And

‘This clinic not only helps those that have been abused, it highlights the issue and helps to STOP it.’

I was surprised but wasn’t as dismayed as everybody else seems to be on learning of this clinic’s closure, because the prevalence and extent of FGM across the country is much less than is generally perceived. I wrote about this just over a year ago in regard to another service: the under 18’s clinic at UCLH. The data for Acton clinic’s use also confirms this trend.

So I believe the closure is a positive step because the need for services there has changed and the demand is no longer as great as it was. And that suitable alternatives already exist nearby, sometimes staffed by the same caring professionals, is a bonus.

The petition tells us that the clinic opened in 2007 in response to the needs of local women unable to access specialist services to help them with the health consequences of FGM. ‘The community setting was chosen to make the service more accessible, less intimidating than the hospital and because it is supposed to be cheaper.’

Ealing in west London where the Acton clinic is located, is London’s third largest borough. In 2015 it had the third most ethnically diverse local population in the UK, both in terms of the number of people from different ethnic backgrounds and how evenly they were distributed across the borough. Black and minority ethnic communities (including mixed / multiple ethnic groups) made up around 54% of the total population. Many people of Somali descent live in and around Ealing and in 2014 the 10 most common languages spoken in school were: English, Somali, Panjabi, Polish, Urdu, Arabic, Tamil, Persian/Farsi, Gujarati, Pashto/Pakhto (in order of the numbers of speakers).

Acton’s fortnightly FGM clinic is one of a number of established specialist services across the UK staffed by health professionals experienced in dealing with clients who have undergone FGM and understand the cultural reasons behind it. A Somali and Arabic speaking advocate/interpreter is also employed there. Self-referrals are encouraged and reversal procedures for infibulated women are carried out by a midwife. The clinic also helps address health concerns that women may have.

The importance of the clinic was recognised in 2011, just four years after it opened when it won the Guardian’s diversity and equality award. By then it had offered 160 women the 30-minute reversal procedure. Another 16 had been referred to hospital and 29 offered help for trauma.

More recently, in February 2016, ahead of the International Day of Zero Tolerance for FGM, MP Jane Ellison, then Parliamentary Under Secretary of State for Public Health, visited the clinic in its new base, Hillcrest Surgery, ‘one of the countries few GP Surgery based clinics for women who have suffered FGM.’

She said then “This Government is committed to ending FGM in a generation in the UK. We have taken bold action so that we now know how many FGM survivors we are treating in the NHS. We are also training thousands of front line professionals to play their part caring for women and protecting girls from FGM.”

FGM survivor and photographer Aida Silvestri confirmed in the petition content  “This clinic is vital for FGM victims. It provides a great deal of support physically and emotionally by creating a safe environment for girls/women to talk about their problems and experiences while maintaining their anonymity. The clinic changes lives and saves lives.”

It would be understandable to assume therefore that a busy service is being delivered here.  But that is not the case.

The petition advises that during the ten years the clinic has been operational, more than 1,000 women have been helped. Of these, more than 500 had reversal procedures, over 200 were referred for specialist gynaecology consultations and over 150 women received counselling. Women have even told staff “this service changed my life after suffering years of pain”.

So 100 women were seen each year, and allowing for 4-5 weeks holiday closure annually, four women would have been seen during the fortnightly, two day clinics. That amounts to two daily. If 500 reversals were carried out over 10 years it means that 50 were carried out yearly, This figure represents just more than one per week and a slight increase from the 40 a year reported in 2011.

Those numbers seem tiny compared with the high prevalence data for FGM cited officially and by campaigners. This has helped result in inaccurate and largely unchallenged media headlines like ‘A case is reported in England every 96 minutes’. While it is true that 90% of all FGM cases are from Africa, that over 50% of all England FGM cases are recorded in London, and one in three are originally from Somalia, there is no evidence that FGM is rife or that figures reported represents a ‘tip of the iceberg’ scenario. In reality the exact opposite seems to be the case.

Additionally, and contrary to popular opinion, there is no evidence that women who’ve undergone FGM are having their daughters cut so the need for specialist services will continue to decrease.

Official data collected by NHS Digital does not go anywhere near corroborating the FGM prevalence rates in England and Wales and local estimates, published by City University in 2015. These estimates were not derived from a bona fide epidemiological study so should not have been accepted and treated by officials, the media or campaigners as though they were.

That’s why I interpret the decision positively. There is no FGM epidemic nationally or locally so the need for these specialist services will inevitably decrease further. But a disparity remains between the panic about FGM and the reality of it and the sooner this is understood and accepted, the sooner we can have an honest discussion about the actual prevalence of FGM and women’s need for specific services.

Presumably the Ealing Clinical Commissioning Group also did its homework before concluding that the clinic should close, knowing that because the issue is so high profile and emotive, there would be a backlash. But given the financial constraints that the NHS operates under generally, (Channel 4’s current 24 hours in A&E set nearby in St Mary’s Hospital, Paddington is testament), the Group probably balanced this service’s need against other service priorities and decided to close it. And it would have known of the planned additional fortnightly clinic at the Queen Charlotte and Chelsea Hospital site, a bus ride away from the Acton clinic. In reality, this means a change in location for the service, not a cut to it.

In an email response to my query the Assistant Director of Communications wrote: “when making the difficult decision not to invest in this service, we took into account that there are a number of good alternative services available, and that the Acton Well Woman Clinic service saw only a small number of women last year.  I do want to emphasise that there are a number of alternative services available for women to access including:

– Imperial College Hospital Trust has FGM clinics run by midwives at Queen Charlotte’s & Chelsea and St Mary’s Hospitals. Imperial College Hospital Trust is planning to operate one additional clinic at Queen Charlotte and Chelsea Hospital site on alternative weeks.

– London North West Hospital Trust has FGM clinics run by specialist midwives at Northwick Park and Central Middlesex Hospitals who are also able to refer to the specialist FGM consultant.

– University College London Hospital run an African Women’s Clinic which is linked to both uro-gynaecology and paediatric clinics.

– Chelsea and Westminster Hospital NHS Trust operates the West London African Women’s Service from both Chelsea and Westminster Hospital and West London Centre for Sexual Health at Charing Cross Hospital.”

So while Acton clinic will move from its current location, a similar service will continue at Queen Charlotte and Chelsea Hospital. Instead of bemoaning the closure we should celebrate that the incidence of FGM is too low to warrant the continuance of the service in the Acton clinic.

Professionals in the new setting will, I’m sure, ensure that the service there continues to offer the high quality care that women need and deserve.