‘There is no good reason to be cut’

In January the first official figures on the number of cases of female genital mutilation in hospitals in England were published. The Health and Social Care Information Centre said 1,946 cases were recorded between September and December last year.

In the north of England 361 cases were recorded by medical staff – 100 from Manchester alone – but with thousands of cases hidden the statistics do little to illustrate the full extent of the practice in the UK.

Female genital mutilation (FGM) or female circumcision is a cultural practice that has existed for millennia. Concentrated in African countries, it is typically carried out on children between the days after birth and puberty, and involves the partial or total removal of the external female genitalia for non-medical reasons. The procedure is usually carried out by a traditional female circumciser with no medical background who uses a blade or razor – often without anaesthesia.

Julie Ward, Labour MEP for the North West, who is campaigning against FGM, points out: “Many people think that FGM is an African problem. They don’t understand that it is a global issue as the practice has migrated along with communities and continues, largely unseen, in many European countries including the UK. It is a particular issue in the North West.”

The NHS estimates that 66,000 women and girls are living with the consequences of FGM, which can include recurrent infections, chronic pain, cysts, infertility and complications in childbirth. Bleeding can prove fatal. Writing after the recent high-profile case of the British doctor accused of FGM, Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists, said: “Dr [Dhanuson] Dharmansena was a junior doctor providing emergency obstetric care to save the baby of a young mother in labour who had suffered FGM as a young girl.

“He was doing, to the best of his ability, what obstetricians do every hour of every day.”

Following the case, which took a year to bring to court and was dismissed in less than 30 minutes, the Crown Prosecution Service was criticised for succumbing to mounting political pressure to get results.

In the week following the trial in February, the government announced plans to make it a duty of frontline professionals to report cases of FGM to the police within a month of encountering them. The move is part of wider plans to tackle the practice.

Crime prevention minister Lynne Featherstone told The Big Issue in the North: “This will make their responsibilities absolutely clear and aid police investigations, ultimately increasing the number of perpetrators caught and prosecuted.”

Dr Samiramis Saba, an obstetrics and gynaecology registrar at Birmingham Women’s NHS Foundation Trust, agrees with this move, adding that she and her colleagues normally report it at the first contact.

The rule only applies to cases where the victim is under 18, however, and the Royal College of Paediatrics and Child Health points out there is no evidence to suggest this will better protect victims. It said the reporting rules may deter parents from accessing medical services for their children for fear of intervention, while others suggest the case of Dr Dharmansena may deter professionals from wanting to help them.

Dr Saba, who regularly comes across cases of FGM, disagrees.

“The latest prosecution was wrongful and it wouldn’t deter me from treating victims… Most of the women we talk to about it are against the practice.”

It is clear however that the practice, which outdates most religions, is culturally embedded. Steeped in gender inequality, FGM is an attempt to control women’s sexuality and is claimed to represent purity.

Naana Otoo-Oyortey, executive director of Forward – an organisation working in the UK to end FGM – explains that while these are cultural reasons, they are reasons nevertheless. For many, failing to circumcise a child is failing to protect them from male sexual initiation, making them unfit for marriage and putting them at risk of social exclusion. Most young girls look forward to being cut, she claims, with the occasion representing their initiation into womanhood and marked with festivities.

As well as campaigning against FGM, Forward works as a prevention and support service for affected communities. Its workers host community discussions – offering a safe place to debate justification for the practice. “Unless people are clear about why they are                                                           practising it,” says Otoo-Oyortey, “they will continue to do so.”

She feels positively overall towards government measures to end FGM but raises concerns.

“Unlike other countries we don’t have a national action plan for FGM.”

“The government is asking people to collect data when most of them don’t really understand FGM. There hasn’t been the training that is needed to be able to reach out and support women better. The government has opted to provide e-learning tools but much as it’s helpful it doesn’t necessarily enable the professionals to have the confidence to deal with it effectively.

“There isn’t a strategic approach or long term plan. It’s very piecemeal and that doesn’t provide a good pathway. Unlike other countries, we don’t have a national action plan for FGM.”

Featherstone explains more about the government’s plans. “On top of this [mandatory reporting] the government has launched a new specialist FGM unit, updated multi-agency guidelines, introduced an NHS prevention programme and is providing training for NHS staff, prosecutors and police.”

While the government acknowledges the work of organisations like Forward is vital, it continues to focus on legislation and prosecution – which has to date proven impossible – while grassroots organisations receive insufficient funding to continue their work.

According to campaigners, engagement and support within communities practising FGM is critically important but the services available to them remain limited, and Otoo-Oyortey says women are reluctant to seek help. Specialist medical clinics are few and far between and emotional support even more sparsely available.

Nestac in Greater Manchester runs a programme delivering emotional support to those who have undergone FGM and those at risk. Founder Peggy Mulongo is a mental health practitioner whose work within African communities has enabled her to challenge FGM locally. A large part of both Forward and Nestac’s work is with young people who have been affected by FGM and who go on to teach their communities about the risks and legal implications.

“We need to make sure we are ready and prepared once disclosures happen.”

“[The government] talks about policies and measures but the message is not really reaching the community,” Mulongo says. “Little is done in terms of community engagement because focus is on preparing professionals. Legislation is good but my concern is we need to make sure we are ready and prepared. Once disclosures happen how can we support them? How prepared are the doctors for what they’ll encounter and what will happen after that in terms of support?

“We’ve started a process but we need to make sure all the gaps are filled in.”

Members of Nestac’s Support Our Sisters project, which supports FGM survivors and women at risk, share their stories. Names have been changed to protect their identity.

Sophia

“I could not show my pain to my parents.”

“I am a 27-year-old British woman of African origin and I live in Manchester. I moved here from Somalia with my family when I was 11. Before I was cut, I knew it would happen as my older sisters went through it as well. For me it was normal – I was waiting for that special day to become like my sisters.

“I still have memories of the cut and of the ceremony, because we celebrate with all other children who were cut on the day. My two cousins were cut on the same day. I cannot describe the pain. It was done in a traditional way, with different sorts of knives. Among the cutters, I recognised my auntie – my dad’s sister – but I didn’t know the other three. I chose not to think too much about what happened. My memories focus on the good time after the cut: the party, the presents and my family being proud of me because I was strong and I became an adult. I was nine.

“My two older sisters, who were 13 and 15, supported me a lot when I was in pain in the days following the cut, comforting me, singing for me and encouraging me, saying I will be OK soon. I could not show my pain to my parents. I wanted to show them that I was strong.

“It was only when I joined the women’s group last year that I learnt about the impact of FGM, and I found out that it was illegal in the UK. In my community here, we don’t talk about this – there’s no reason why we should. I went through counselling for seven months – it was my first time talking about FGM since it has happened.

“Now I know that there is no good reason to be cut, but still lots of people in my community strongly believe in it. My feelings for my parents and my family are still the same – I understand it is not their fault and I am trying to educate my family and other people in my community.”

Amina

“I was so stressed about discussing FGM at home.”

“I am 21 from Senegal. I came to the UK with my parents and my siblings when I was 14. I was cut when I was 12. It was done at the hospital and it wasn’t painful.

“When I listen to other people’s stories, I consider myself lucky. My mum took me to a female doctor, and she removed my clitoris and my inner labia. The doctor explained what she’d removed. She said it wasn’t normal for a girl to have them on their body and that it would help me be clean and prepare me for marriage. It was natural and normal – most of my friends were already circumcised.

“Back home I had some presents from my aunties and uncles and a big meal was organised for the family. I had a new dress for that special day and I was happy. My aunties said that it was part of our tradition, and I was proud to be considered in the society, although I was young. I am the only girl in my family and I did not have any complications or pain after the cut.

“I joined the SOS Youth Project three years ago, as they were promoting cultural art activities and I love art. We developed a short film on FGM and staff educated us on FGM. That’s when I realised that the doctor had lied to me. It is not good for a girl to have part of her genitalia removed. I felt frustrated and I questioned myself a lot but I was scared to question my parents. I was so stressed about discussing FGM at home – I couldn’t sleep properly for weeks.

“I sought help at the project and went through individual therapy. Last year I became a youth advocate. My first challenge in this role was to find the courage to talk to my parents but I knew I had to do it to protect other young girls in the family. Their reaction at first did not surprise me – they were offended, upset and even feared being excluded from our community, but I was prepared. I received lots of support from staff and volunteers at SOS, who asked me not to give up on speaking to my parents and family, and to invite them to awareness events.

“It took a few months for my mum to finally come to one but she was curious about why I’d become a campaigner. At the end of the awareness event, my mother talked to me, in tears, and said she learnt more in half a day about the dangers of FGM than she had her entire life. I felt so proud, so capable of doing more. My fear disappeared as my mother freed me from the social pressure I was constantly living under. I am no longer afraid to discuss this problem at home, with my extended family here or at school.”

Fatou

“I will never have my children circumcised.”

“I am Fatou, 45, from Gambia. I’ve been in the UK for 21 years and I have three children – two girls and one boy. I was cut when I was seven. In my country, we are happy when it comes to cutting season – there are parties and presents and I was happy to be cut. The night before I couldn’t sleep for excitement. My life would change for the good. I would become an important young girl in the community.

“The cut was horrible. I suffered a lot, bleeding for days and was ill after that. I missed the ceremony with the other young girls. My presents were at home waiting for me, but I was not as happy as before the cut. I can still remember the two women who were holding my legs while I was crying and shouting. For a long time it was in my head every day but I couldn’t talk about it. I was sad because for the other girls all went well, but I had to stay behind – I wasn’t strong enough and my friends mocked me when I went back to school.

“I entered an arranged marriage when I was 17, just after I finished secondary school. I had difficulties falling pregnant and my mum took me to hospital every six months to see if I could have children. Eventually my in-laws brought the dowry back to my parents – I was an infertile woman, not good for marriage. In my family I was seen as a cursed woman, good for nothing. Three years later I moved to the UK.

“I rejected my community in the UK for fear of them rejecting me first. I chose to live with other communities, where I met my actual husband, who is from African descent but a community that doesn’t practise FGM. He accepted me as a sterile woman but suggested we could visit doctors for help. Results revealed that I had complications due to infections developed inside after circumcision. I received treatment and we were patient. My husband was very supportive. It was years before I fell pregnant with my girl.

“I knew then that FGM was very bad and I will never have my children circumcised. I’ve been in therapy these last two years to heal from the trauma of FGM and I decided to give my time volunteering and educating people in the community. I am so happy to organise sessions in the community and talk about FGM.”

ANTONIA CHARLESWORTH