Analysis

FGM remains a hidden crime, say MPs

Female genital mutilation (FGM) is a hidden crime and a ‘national scandal’, MPs have warned. 

Female genital mutilation (FGM) is a hidden crime and a ‘national scandal’, MPs have warned.

Though illegal in the UK since 1985, no one has ever been prosecuted for FGM. Under laws rolled out last year, nurses, midwives, doctors and teachers have a mandatory duty to report FGM cases in under-18s to police.

Now a new report from the Commons home affairs select committee described the absence of a successful prosecution for an FGM offence as ‘beyond belief’.

Ignoring responsibility 

Yet also of concern to the committee are reports some clinicians are ‘ignoring’ their legal duty to report cases.

‘We are alarmed by reports that some clinicians are ignoring the requirement to record data on the basis that they do not recognise its purpose,’ say MPs.

‘We expect NHS employers and the Royal Colleges to take a hard line against such attitudes and call for the Department of Health (DH) to write to front-line clinicians to remind them of the duty, and the purpose of mandatory recording, and to reissue guidance.

School nursing cuts 

‘In areas where recording is far below expectations, training on the harm resulting from FGM, the importance of fulfilling the duty to record FGM incidence, and dealing with affected women should be commissioned.’ 

The RCN says cuts to the school nursing workforce and workforce pressures are adding to the difficulty around identifying and eradicating FGM.

5,700

The number of new FGM cases in England over the past year, according to NHS Digital.

The first-ever publication of statistics on FGM by NHS Digital in July revealed 5,700 new cases in England over the past year.

No area free

City University professor of perinatal health Alison Macfarlane is the author of a 2015 report that estimated the prevalence of FGM in every local authority area in England and Wales.

It suggested that no local authority area in England and Wales is likely to be free from FGM entirely. Southwark in London had the highest national prevalence with an estimated 4.7% of women affected by FGM, and also the highest percentage of girls born to mothers who had undergone FGM, at 10.4%.

These estimates included only women born in countries where FGM is practised and do not include any women born in the UK who may have been subjected to FGM.

Potential deterrent 

Professor Macfarlane says it is important to remember that even though cases of FGM recorded by health professionals may be described as ‘newly reported’, they can include women who were subjected to FGM many years ago in their countries of birth. 

‘It would be better if FGM was included in routine data collection systems about women’s health within the NHS, rather than in isolation, and there is a worry that the reporting system may deter women and girls from accessing the care they need.’

582

The number of cases involving girls aged five to nine years (43%), making this the most common age range at which FGM is undertaken.

Founder of the FGM national clinical group and consultant midwife Yana Richens says the group has lobbied for national FGM data reporting. ‘Our argument is that we can’t help people unless we know how they are affected, whether that be mental health or giving birth.' 

More awareness

‘We know the data is poor and in terms of midwifery, a lot of health professionals weren’t used to asking that question. But the fact is that clinicians are being made more and more aware of FGM, and there are far better services because we are seeing increased reporting.

‘I can see it in practice with student midwives, they are talking about FGM because they have been taught about it at university and they challenge clinical practice and what you do.

‘There is a willingness among health professionals to help women affected by FGM and while I wholeheartedly agree that a prosecution for FGM would be great, we do need to focus on the mental health of women.

Publicity, funding

‘We don’t know how many women are infertile as a result of FGM. We need publicity and funding, so women know they can go to their GP and talk to health professionals.’

So what resources are out there to help nurses in tackling FGM?

The RCN published its own guidance on FGM earlier this year, while the DH released four videos in August for healthcare workers covering the mandatory reporting duty and how to help a patient affected by FGM.

Clarity needed

Guy’s and St Thomas’ NHS Foundation Trust FGM/public health specialist Comfort Momoh appears in the videos.

She believes there is still a lot of confusion among nurses and other health professionals about whether or not they should be reporting every case of FGM to the police.

Dr Momoh, who trains health professionals about FGM in the UK and internationally, says: ‘Nurses have so many more tools to help them deal with cases of FGM than they used to, but they need to make sure they can identify FGM, know how and where to refer patients, and how to record data.’

New FGM resource for nurses

Public health nurse Joanne McEwan received funding through a Mary Seacole programme leadership award last year to develop an iPad app to help prevent FGM.

Ms McEwan, who works for Oxford Health NHS Foundation Trust, says she regularly comes into contact with FGM survivors during her work as a health visitor.

More than half of all cases relate to women and girls from the London NHS Commissioning region – 52% (2,940) of newly recorded cases and 58% (5,020) of total attendances.

The free app, which is now available from iTunes, includes soundbites of key information in five languages about the impact of FGM, why it happens, the law and how to protect children, as well as providing local support for survivors.

It also includes video interviews with FGM survivors, campaigners and clinicians who support FGM survivors.

She says: ‘Health professionals need to be culturally competent to understand the people they are working with and be able to identify how and when any questions about FGM should be asked in a sensitive manner.

‘Nurses can use all the skills they have learned and even if they haven’t come across the situation before, they must remember that women willing to engage, they are often just waiting to be asked.

‘I work in an incredibly diverse community and we have to work with the county council and other bodies to support these women. I know there may not be the same level of support in all areas of the UK, but we shouldn't forget that care needs to be inclusive and if we can help just one more person with FGM it will be worth it.’

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