FGM/C awareness raising: professional concerns

In addition to public awareness-raising campaigns about FGM/C, professional conferences are also held to educate and inform. Some are targeted at specific disciplines e.g. health professionals.

Many are run by the Department of Health’s FGM Prevention Team, in partnership with the Home Office FGM Unit. Many professionals have attended specific DH ‘Protecting against FGM and caring for survivors’ events, nationwide. The 10th was held in East London in March ’15 and attracted approximately 150 professionals.

Other events attract multidisciplinary audiences and are organised by professional conference organisers like pavpub.com. Attendance is encouraged from education, social care, police and the third sector as well as health. The conference remit is generally to share information about FGM/C and to discuss how this ‘high priority safeguarding issue’ can be prevented.

The events provide attendees opportunities to hear from the ‘experts’ and ‘victims/survivors’, to familiarise themselves with the practice and understand why it happens. Raising questions and concerns and networking is encouraged.

I’ve attended a number of these FGM/C awareness raising events and have found them illuminating, chiefly because of the concerns that attendees share because they have to deal with them in practice.  Included are:

• Identifying children who’ve undergone FGM/C

We are told that an estimated 7000 girls are at risk of being ‘mutilated’ and that the practice is being carried out abroad during the so called ‘cutting season’ or in Britain by cutters flown in especially. The estimates are based on the number of women coming from countries with high prevalence rates of FGM/C, or daughters with parents from those countries. Diaspora communities, we are told, tend to cling to these traditional practices.

But nobody I’ve met, not even professionals working in child protection in ‘high risk’ areas, have seen or heard of a child who’s undergone FGM/C. But because of the heightened awareness in regard to it, many believe that it must be happening in boroughs other than the ones they work in.

But in the absence of any evidence, some professionals are beginning to doubt that British girls are being cut, here or abroad. If they were, they say, the information would be shared among them and spread like wildfire. And because children talk, someone, somewhere would spill the beans if it had happened to them or their friends. And they might present to a health service with associated problems. But they don’t.

• Recording mothers’ sensitive FGM/C status in their child’s PCHR/’Red Book’

In April 2014, it became mandatory for NHS health professionals to record, within a patient’s clinical record, if they identified through the delivery of healthcare services, that a woman or girl had undergone FGM/C. But this sensitive information is also now to be recorded in her child’s personal health record, commonly referred to as the ‘Red Book’.

In addition to recording basic data like a child’s name, NHS number and date of birth in the first section of the Red Book, personal information such as parents’ names and history, as well as the details of the mother’s birth experience and discharge from hospital is included.

And while health practitioners and parents are the main users, others like nursery and school staff and childminders who work with young children can ask to see and write in it.

This worries health practitioners sensitive to the fact that this private information about a woman is not only shared with her child(ren), but potentially with others who come into contact with them as they grow up.

The DH suggests ‘It remains best practice to share information between healthcare professionals to support the ongoing provision of care and efforts to safeguard women and girls against FGM. For example….to include that there is a family history of FGM within the PCHR.’

So this sensitive and delicate information about a mother’s FGM/C status is to be recorded for others, not necessarily of her choosing, to see. And unless the mother an/or child ‘loses’ the Red Book or refuses to share it with others, they can see this private health information.

But if either ‘lose’ it, professionals are encouraged to consider whether there might be an associated safeguarding (child protection) concern. And if they refuse to share it, they’d have to deal with the suspicions that might arouse. Seems they can’t win.

Centralising Patient Identifiable Data and the associated ethical problems

All of this is very worrying. But is justified, based on the widely promoted view that if a woman has undergone FGM/C she’s more likely to have her daughter cut. Some however don’t share these ‘deterministic’ views. And are angry and upset about them.