FGM prosecutions and the question nobody dares to ask

The acquittal of Dr Dhanuson Dharmasena yesterday means that more than 20 years after specific legislation was passed, there remains not one single British conviction for inflicting female genital mutilation (FGM).

The case against the obstetrician was always a strange one. His patient was a survivor of previous Type 3 (ie the most severe) form of FGM, and after saving her life with an emergency operation during labour, he stitched her up in such a way that appeared to restore her post-FGM state of mutilation, rather than reverse it. Dr Dharmasena always insisted that the suture was no more than necessary to stop her bleeding. The jury took less than 30 minutes to rule him (and his co-defendant) not guilty. All medically-trained observers who have followed the trial now seem to agree that the verdict was correct and the charges should never have been brought.

So why were the charges brought and pursued so vigorously? I can only presume it is a consequence of the enormous pressure being felt by the CPS and other agencies, including the police, to begin securing convictions for FGM offences. If anyone still believed that the powers-that-be are scared or shy of prosecuting FGM cases for fear of appearing culturally insensitive or racist or whatever else, the ill-judged prosecution of Dr Dharmasena should set them straight.

I’m something of a lone voice on this issue, because I have never been entirely convinced that political correctness and cultural relativism are the primary obstacle to identifying cases and securing convictions. Perhaps if we go back far enough – into the early years of New Labour and back through the 90s and 80s, there might have been a toxic combination of ignorance and political correctness that led some professionals to turn blind eyes, but for at least 15 years now every professional in health, social care, education and even the youth, voluntary and community sectors (where I worked for about a decade) has been inundated with instructions, policies, guidelines and rules for identifying or acting upon suspicions that a girl is at risk of FGM.

No one is now in any doubt that FGM represents a severe and horrfic form of child abuse and no one is unsure what steps to take if a case comes to light. Especially over the past five years, with the nation broadly horrified and stunned by the child grooming scandals in Bradford, Rotherham and elsewhere, the idea that significant numbers of professionals would routinely ignore cases of FGM for fear of appearing racist or out of respect for cultural differences is downright fanciful. I live and work in inner city Manchester, around large African and Asian communities, and I have friends who are teachers, doctors, youth workers and social workers. I would be astonished if any one of them would not act properly if they discovered a crime of FGM.

So what is the reason for the lack of prosecutions?

I’d suggest there are two more credible explanations.

The first is an obvious one. it is a very, very difficult crime to detect. Victims are highly unlikely to cooperate with prosecutions because to do so would put their own loved ones (usually parents) in prison. Under such conditions, victims (or their carers) may avoid gynaecological checks and interventions because they know that to do so might trigger investigations. Unless there is a life-threatening emergency, a couple of decades could easily pass between a girl being cut and any medical professional having a look at her gynaecological condition. Even then, unless she is willing to testify, it would be impossible for investigators to establish how she came to be mutilated.

The second explanation is more controversial. As I have written before, the evidence as to the extent of FGM in Britain is far more tenuous than the mainstream debate normally allows. Campaigners, journalists and politicians hide behind such phrases as ” X thousands of girls are at risk of FGM every year” which are almost entirely meaningless. What is certain is that there are several thousand women in Britain who have survived FGM. Recent statistics confirmed this – at least 1700 women are currently known to be under treatment by NHS trusts. However, the key question which has not been answered is when these women were cut, and what their life circumstances were at the time. While there will always be complex individual circumstances, in broad terms there are three situations in which a girl in Britain might have been subjected to FGM.

1. She is born and raised in the UK, and subjected to FGM by someone in the UK.
2. She is born and raised in the UK and taken out of the country to be subjected to FGM in her country of heritage (or elsewhere) before returning.
3. She is born and raised in another country, subjected to FGM while there, then migrates to the UK at a later date.

Categories 1 and 2 above both involve a crime occurring under British law. Category 3 does not. While we know that there are thousands of women who have been subjected to FGM, we literally have no information, no data at all, as to how many of them belong in Categories 1, 2 or 3.

The possibility (which nobody seems willing to publicly acknowledge) is that the overwhelming majority of affected women in the UK belong in Category 3, which would mean that no crime had been committed under UK law. If this were the case, it would provide another very strong explanation as to why the authorities have failed to successfully prosecute people for FGM crimes. It would be because very few FGM crimes have occurred in this country in the first place.

Is this credible? Before discussing further let me reiterate that there certainly are some cases of British national or resident girls being cut, either in Britain or (more commonly) after being taken out of the country. I am not saying such cases do not exist – a couple of survivors are interviewed first hand here.
I am however suggesting that it is possible – not certain, but possible – that the numbers of such cases are far, far smaller than the popular debate and discussion generally allows. Beyond a handful of personal accounts, the evidence is dependent upon hearsay, rumour and assumption (as the article linked above demonstrates quite clearly.)

Let us suppose for a moment that a significant number of girls were either being mutilated in secret ceremonies here in the UK or taken out of the country during the school holidays, for instance. FGM, usually performed by untrained practitioners using non-sterile, non-clinical equipment and venues, carries a high risk of immediate and short term complications and sequelae. Here is an extract of a study on the attendees of an African Well Women clinic in London.

’57 of the 66 women (86%) reported at least one acute complication, of which severe pain was experienced by 48 (73%), particularly among those in whom the procedure was carried out at an older age. Eight women (12%) remember requiring hospital admission for presumed septicaemia after the operation requiring intravenous antibiotic treatment (5/8), or severe haemorrhage requiring blood transfusion (3/8). Five other women (8%) had the procedure reversed because of acute urinary retention (2/5) or localised infection or abscess (3/5), and all five were re-infibulated (re-stitching of the vaginal orifice) a few weeks later.’

Most of this is not the kind of condition that clears up with a couple of days in bed and an aspirin. If hundreds of British residents were being mutilated every year, we would expect to see a reasonably high proportion turning up in A&E soon after, with blood poisoning or uncontrolled bleeding, or if untreated, turning up in the morgues. Where are these cases? Is it credible that they are indeed happening but passing unnoticed, not leading to police involvement, investigations, prosecutions? It is possible, but as the years go by, it looks increasingly unlikely.

All calculations about the extent and risks of FGM carry a huge assumption – that people from communities which practise FGM in their lands of origin will continue to practise after migrating. As the website Full Fact notes here, even the authors of the reports which provide the statistics acknowledge that this is an entirely unsubstantiated assumption. Meanwhile, if you read the study of the African women above, it explains that even despite all the medical complications and horrors, almost 6% were seriously considering having their daughter undergo genital mutilation outside the United Kingdom. Another way of presenting these figures would be that 94% of African FGM survivors in London said they did not intend to inflict FGM on their daughters. That is a massively significant finding.

A few years ago the press got very excited about an FGM scandal in Sweden.

As the Guardian explained:

When Norrköpings Tidningar reported that every single girl in a school class of 30 had turned out to be circumcised – with 28 of them having their clitorises and labia cut away and their vaginas sewn almost shut – it was picked up by the media across the world, including by UK broadsheets.

In fact the girls, aged 13-18, were part of a group of newly arrived immigrants from FGM high-risk countries brought together for an educational session as part of a new pilot project being launched in Norrköping. They had all been circumcised in their home countries.

How typical is this case, both in the nature of the abuse and the inaccuracy of the reporting? I honestly do not know, My suspicion is that it may be the norm, not the exception.

There may be a glimmer of light on the horizon here. The Office of National Statistics has begun collecting data on FGM cases in the NHS, as I quoted above. At the moment only the headline data is being reported, the data collection is still being described as a pilot exercise. We are promised that later this year, more detailed data will be made available. I very much hope that these data will include the following question:

Was the patient a UK resident before the point at which FGM was performed?

That question alone would be extremely instructive. I can see no ethical or practical reason why it should not be asked by NHS staff when taking a history. It would allow us to know whether resources being spent on attempting to police and prosecute FGM are being frittered away on a wild goose chase.

In many respects FGM is a perfect candidate for a classic moral panic. It involves secret, inaccessible facts which cannot easily be challenged. Many people have political motivations to push the agenda. This includes racists, Islamophobes and xenophobes who use it as a stick to beat immigrants or as supposed evidence of the failures of multiculturalism, but on the other side, progressives, feminists and liberals for whom it stands as an iconic symbol of patriarchal brutality and also (conversely) a demonstration of how unaffected they are by cultural relativism.

Nobody has anything to gain from challenging any statement about the extent and prevalence of FGM, even people from the communities involved know that to do so would have them marked out as apologists or defenders of the practice. Consequently the mainstream narrative on the issue is not a case of everyone pushing at an open door so much as everyone pushing at a revolving door, their collective momentum driving everyone on faster and faster, even if they are starting from entirely opposite directions.

This does not mean that everyone involved is wrong. It does mean it is a situation where everyone should be aware of the potential for sociological myths to emerge.

I repeat for the final time, I do not know for a fact what is going on. I am simply observing that nobody else really knows either. If my suspicions prove broadly correct, I would be very happy – not to be proven right, but because it would mean that there have been far fewer acts of horrific abuse committed on young British (or British-resident) women and girls than previously supposed. If I am wrong, I hope no efforts are spared in pursuing and prosecuting those who are committing these offences.

If, however, the question continues to go unasked, I could only conclude the reason is that nobody really wants to know the answer.

Transcribed with permission from Ally Fogg’s FreeThought Blog published 5 Feb 2015