Opinion

Be part of the answer to FGM

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Primary Health CareUntil very recently, it seemed that the campaign against female genital mutilation (FGM) was gathering strength. Then, on February 4 2015, a jury took just 15 minutes to find Dr Dhanuson Dharmasena not guilty in the first FGM trial in a British court.  Dharmasena, then registrar in obstetrics at Whittington Hospital in London, had restitched the labia of a Somali woman to stop bleeding following delivery of her baby. Instead of suturing on either side, as later advised by superiors, he had performed a figure-of-eight stitch to reinstate the closure. Medical colleagues argued that this prosecution was wrong: Dharmasena had simply acted in the patient’s best interests, and this was hardly an example of the ritual practice targeted by campaigners.

After the verdict at Southwark Crown Court, many commentators criticised the Director of Public Prosecutions Alisson Saunders for an apparently rushed decision to take this dubious case to court. The decision was announced four days before MPs were due to question her over the failure to prosecute anyone with the crime, despite it being an offence since 1985. Such criticisms may be valid, but there was also a troubling amount of comments on newspaper websites to the effect that FGM is exaggerated and a cultural practice that should be left alone.

Denial and an unwillingness to act on FGM has been an ongoing problem. Yet the government plans to make it a criminal offence for healthcare practitioners to fail to report FGM. Going back to the Dharmasena case, the defence argued that the doctor was being made a scapegoat for the hospital, which had failed to provide training on FGM. The doctor who performed the stitching was not at fault, according to the defence, but the midwife who first saw the patient in an antenatal appointment was implicated. The midwife had asked standard questions about FGM and the woman had replied ‘It’s fine; it’s opened’. Hospital policy states that the midwife should have organised deinfibulation (reopening of the vaginal orifice) as part of a birth plan in advance of labour. This was not done, leaving the doctor to perform the opening in an emergency admission.  

Nurses and midwives must be alert to the higher expectations and legal responsibility imposed on their practice. While it has been easier to do nothing in the past, recording and reporting FGM will no longer be optional. Practical guidance from the RCN is available, and practitioners should also press for training to be provided in the detection and response to observed or suspected cases of FGM. It may not be long before a midwife or nurse is taken to court for failing to act. Cultural sensitivities are a major challenge, but if we really want a multicultural society that is fair to all, nurses and midwives must contribute to the eradication of a needless violation of young girls. Let’s make sure that we are part of the answer, rather than part of the problem.

About the authors

Mental health programme leader Niall McCrae and child health lecturer Sheena Bynoe, from London’s  Florence Nightingale Faculty of Nursing and Midwifery at King’s College, have written a peer reviewed article on the role of nurses in preventing and addressing FGM which was published in the March 2015 issue of Primary Health Care.

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