Policy Briefing on Female Genital Mutilation (FGM)
Article 24.3 of the United Nations Convention on the Rights of the Child
obliges states to: ‘take all effective and appropriate measures with a view to
abolishing traditional practices prejudicial to the health of children’.
‘Honour’ based violence is a form of violence against women and child
abuse. It is also an abuse of human rights. Forms of ‘honour’ based violence
are complexly embedded in families, generations, communities and culture
and as such can be difficult for practitioners to recognise and confidently
respond to. These forms of violence are closely linked to control of women,
and strive to enforce the compliance of women in communities, thereby
perpetuating the subordination and gender inequality of women in society.
This briefing will focus specifically on female genital mutilation.
All quotes in this briefing are taken from focus groups led by the WNC and
AVA in 2009/2010.
What is FGM?
FGM is defined by the World Health Organisation (WHO) as the range of
procedures which involve ‘the partial or complete removal of the external
female genitalia or other injury to the female genital organs whether for
cultural or any other non-therapeutic reason1’.
There are four main ‘types’ of FGM depending on the type of cut that is made.
Type 1 – the clitoris or the clitoral hood is cut off
Type 2 – The clitoris and inner lips are removed
Type 3 – The clitoris, inner lips and outer lips are removed and the skin
is sewn to leave only a small opening (infibulation)
Type 4 – all other harmful procedures (pricking, piercing, burning,
scraping etc)
FGM can be performed on babies and toddlers, but it most often happens
when girls are between the ages of 4-10, most commonly before they enter
puberty. The World Health Organisation estimates that around 100-140 million
women alive today have undergone FGM.
1
World Health Organisation, (1996) Female Genital Mutilation: An Information Pack, WHO,
Geneva
Where is FGM practised?
It is estimated that around 24,000 girls under 16 could be at risk of FGM in
England and Wales. However it is very hard to obtain accurate figures. It is
thought that up to 2000 British schoolgirls could be at risk of undergoing FGM
this summer (2010). Some will be taken abroad, whereas others will be ‘cut’ in
the UK, often at what is increasingly becoming known as a ‘cutting party’
whereby a FGM ‘practitioner’ is brought in to cut several girls at a time in an
effort to save costs. Until the 1950s FGM was used in England and the US as
a "treatment" for lesbianism, promiscuity, masturbation, hysteria, epilepsy and
other "female deviances"2.
Most of the women and girls from practising communities live in major UK
cities, and numbers are rising due to immigration. It may also be an issue in
smaller towns due to refugee/asylum dispersal policies.
Communities that are most at risk3 of FGM include Kenyans, Somalis,
Sudanese, Sierra Leoneans, Egyptians, Nigerians and Eritreans. However
women from non-African communities that are at risk of FGM include Yemeni,
Kurdish, Indonesian and Pakistani women. In some countries,
(e.g. Egypt, Ethiopia, Somalia and Sudan), prevalence rates can be as high
as 98%)4.
Why is FGM practised?
The origins of FGM are complex and justified by deeply ingrained beliefs by
the cultural groups who practice it. An uncircumcised woman will stand very
little chance of marriage and will not be accepted by her community5.
Some common reasons given include:
• Custom and tradition
• Social acceptance
• Cultural identity and heritage
• Hygiene and aesthetics
• Maintaining a honour and virginity
• Ensuring marriage prospects
• Acceptance
• Repressing sexual desire
• Prevention of rape
• Increased sexual pleasure for the man
• Religious reasons (although no holy texts support this)
• Purification
2
‘British girls undergo horror of genital mutilation despite tough laws’. Observer article; July
th
25 2010.
3
http://www.fco.gov.uk/en/travel-and-living-abroad/when-things-go-wrong/fgm/professionals
4
http://www.forwarduk.org.uk/key-issues/fgm
5
http://www.forwarduk.org.uk/key-issues/fgm
Difficulties in identifying girls at risk of FGM
- It is a one off event
- There are limited reasons to examine a girl’s genitalia
- Most cultures do not enable girls to discuss FGM openly
- Families may give no other cause for concern
Girls are at increased risk if:
- Their mother/siblings have undergone FGM
- The mother-in-law has a great deal of influence in the family
- No-one has ever raised the issue or provided information to her
The summer holiday period is believed to be the most prevalent time for
FGM to be carried out.
Signs to look out for:
- Knowing that a family belongs to a community in which FGM is practised
and making preparations for the child to take a holiday,
- Prolonged absence from school, with notable behaviour change on return
- Possible bladder or menstrual problems, or reports of pain between the legs
- Child may also talk about a ‘special procedure/ceremony/party’ that is going
to take place.
Please refer to www.forward.org.uk/download/10
FGM as a health issue
FGM can have serious short and long term health implications. It is often
carried out by older women with no medial qualifications. Basic tools such as
scissors, knives, razor blades and pieces of broken glass are used with little
or no anaesthetic.
In extreme cases FGM can result in death as a result of bleeding, infection
and shock. Due to the small opening, it can be very difficult for women to pass
urine and menstrual blood and can lead to fatal complications in child birth.
Other complications include:
Scarring
Cysts
Pain during sex
Infertility
Severe tearing (fistulae)
Incontinence
HIV infection (due to the use of a shared instrument to perform the cutting)
Obstructed labour – leading to neonatal brain damage
FGM can also result in long-term psychological issues including:
• depression
• impaired cognition
• sleeplessness, recurring nightmares
• loss of appetite
•
•
weight loss or excessive weight gain
panic attacks.
Even if the procedure takes place in a sterile hospital, this does not alleviate
the long-term negative impacts of FGM.
I had a daughter in the UK in 1984, in the
hospital they nearly ran away from me when
they saw! There wasn’t anyone who
understood Somali culture; they had to find a
Sudanese doctor, who told the midwives to cut
me open. Back then they didn’t know, but they
know more now. Everybody is aware, more
helpful. If a woman is pregnant, they will book
an appointment for you at about 7 months, and
they will open you.
Some see FGM as a form of social conditioning, which prescribes gender
identity and normalises pain for women. This is turn can influence how they
see themselves and their role in society6. While the ceremony surrounding
the cutting is supposed to give the girl a sense of pride at becoming a woman,
the procedure is so traumatic and painful that it can have long lasting
psychological implications.
Sexual intimacy is often very difficult. In some cases the scars need to be cut
before penetration can take place. Some men find this very difficult and it can
lead to them becoming impotent.
It is important to note that not all women experience health problems,
and some who do may not attribute them to their FGM. Similarly, not all
health professionals may link health problems to the procedure,
especially if they do not know it has taken place.
6
FORWARD (2002) FGM Information Pack
Females have to suffer three times,
circumcision, marriage she will have
another operation, and childbirth they will
be opened, and some have physical and
psychological problems all their lives,
gynaecological problems, incontinence,
some women can’t control their bowels.
FGM as an education issue
FGM can have a significant impact on a girl’s education due to absenteeism,
poor concentration, low academic performance and loss of interest. The loss
of social opportunities also plays a huge part.
It is also crucial to ensure that FGM and related issues are included in school
curriculums.
Health professionals also need to be aware of the issues surrounding FGM
and its implications. This should be part of their initial and ongoing
professional training. Training needs to include medical information (for
example, in Egypt, sexuality and the functions of the external female genitalia
are not taught in medical schools7), cultural sensitivity, preventative measures
and counselling techniques.
FGM as a religious issue
The main thing is the men are starting to
think it is against Islam. Before they
thought it was from the Prophet and
from the Koran. But how many Islamic
countries are there where they don’t
practice circumcision? The more we
know about religion, the more we realise
it’s nothing to do with religion.
7
International Planned Parenthood Federation (2008) FGM – Briefing Paper
There is no evidence to support FGM as part of any religion; in fact FGM was
practised before the advent of Islam, Judaism or Christianity, however many
people think that it is a part of their religious duties.
Islamic scholars and clerics have spoken out against FGM and stress that
carrying out FGM goes against their teachings of not inflicting harm on others.
FGM is also practised by Christians, but again there is no evidence in the
Bible to support it. Also, although Judaism requires circumcision for males, it
does not do so for females.
What the law says
FGM is a human rights issue and an act of violence against women, and
cannot be separated from the many forms of gender-based discrimination
which should be acted upon by governments.
The Female Genital Mutilation Act (which replaced the Prohibition of Female
Circumcision Act, 1985) was introduced in 2003 and came into effect in March
2004.
The Act:
•
•
•
•
makes it illegal to practice FGM in the UK;
makes it illegal to take girls who are British nationals or permanent
residents of the UK abroad for FGM whether or not it is lawful in that
country (known as extraterritoriality);
makes it illegal to aid, abet, counsel or procure the carrying out of FGM
abroad;
has a penalty of up to 14 years in prison and/or a fine
Who is protected by the act?
This law protects girls and women who are British nationals or have
permanent residency in the UK. However, it is important to note that all girls,
no matter their immigration status, are protected under UK child protection
laws. Government guidance8 suggests that ‘child protection policy (relating to
FGM) should focus on preventative strategy involving community education’.
It is also possible to use section 47 of the Children Act (1989) if you believe a
child is at risk of, or has already experienced FGM.
As yet there have been no prosecutions for FGM in the UK, although two
doctors have been found guilty of serious professional misconduct before the
General Medical Council.
The Metropolitan Police have a special Child Abuse Investigation Command
dealing with FGM (Project Azure). This project monitors targeted schools and
8
Dept of Health (1999) Working Together to Safeguard Children
airports, and advises parents of the illegality of sending their daughters
abroad to undergo FGM. This has resulted in 20 successful interventions.
It has been controversial because there is a small
minority that don’t feel comfortable with the law; they
feel the girls should be circumcised. But most
people feel it is good to have something to follow,
we live in this country, we have to follow the law. It is
difficult, most people don’t know what the
punishment is if we circumcise girls, we need more
awareness inside the community.
Where FGM appears in policy
UN Declaration on the Elimination of Violence Against Women (1993) Article 2 states that ‘all violence against women shall be understood to include
'female genital mutilation and other traditional practices harmful to women’
Article 4 has direct relevance to FGM in that it requires that states should not
prioritise any custom, tradition or religious consideration above their
obligation to eliminate violence against women
Beijing Platform for Action of the Fourth World Conference on Women
(1995) - condemned FGM and reaffirmed the need for government action to
improve
the status and health of women, and to eliminate gender-based violence.
London Safeguarding Children Board procedures on ‘Safeguarding children
at risk of abuse through female genital mutilation’9 (The procedures
include useful decision making flowcharts)
What women say
There was a lady like us, she went to Somalia to raise awareness to stop
circumcision, an old man told her to go back to where she had come from, our
girls need to be circumcised to make sure they are virgins, nobody can touch
her until she is married; they need to be sealed up. The more she is closed,
the more value she has. In our country they give a dowry, 50 camels, 100
camels. He said go back to your country, if we stop circumcision who is going
to marry our girls, who will pay the dowry? They sent her away. In general
9
http://www.londonscb.gov.uk/procedures/supplementary_procedures/
things are improving, but back home; they are still deeply practising
circumcision.
It is very important for the community. Some men’s families want to see the
circumcision before they marry. The quality of the girl depends on how the girl
is circumcised. Now in this country we don’t know what we will face now we
don’t have this, when we get married, it’s part of our culture. We don’t know if
the man’s family might have similar ideas to us, or more traditional. We know
it is bad for humanity, bad for health, bad for everything, but it is part of our
culture.
Really it’s very painful, luckily we had anaesthetic, without anaesthetic, they
have to drum to hide the shouting because the girl will cry a lot. Two big
ladies, they have to hold her down and hold her legs apart. They have to drum
so the neighbours won’t hear. There is no medication for the bleeding, so they
do it when it’s cool, they think there is less chance of bleeding.
Potential ways forward
Ways to support women and girls who have experienced FGM
• Specialist midwives in labour wards
• Interpreters in the labour room are needed so that health professionals
can communicate with women giving birth
• Clear protocols on multi-agency information sharing
• Specialist counselling
Ways to prevent FGM from happening
• Professionals to have specialist training on FGM (statutory, voluntary
and community organisations)
• FGM to be discussed in schools to raise awareness
• Support for community groups to provide education to practising
communities
Trust for London, Esmee Fairbairn Foundation and Rosa Fund, three
independent charitable organisations, have collaborated to establish a UKwide Special Initiative to fund community based, preventative work to
safeguard children from the practice of Female Genital Mutilation. By
supporting organisations based within practising communities, the initiative
will strengthen the voice of women and children already affected, or at risk of
genital mutilation in all its forms. Approximately £1million has been invested in
15 organisations across the UK.
Examples of organisations who have received grants are:
Africa Advocacy Foundation - Sacred Bodies project which includes the
employment of a part-time worker and a programme of community
development work with small community groups in south London to raise
awareness of the harmful practice of FGM. The work will be in partnership
with North Brixton Islamic Cultural Centre.
Black Women's Health & Family Support - Project that will build on its
extensive work with young people through the Peer Education Project to raise
awareness of FGM amongst a wider range of young people, community
elders, and newer communities. It will also offer training for health
professionals, schools, social workers, community organisations and youth
workers.
British Somali Community - Part-time outreach and advocacy worker to
establish the Himilo (tackling) FGM Project. A significant element of the work
will be empowering young people to speak out against the practice.
For more details: http://www.trustforlondon.org.uk/special-initiatives/femalegenital-mutilation-fgm/
Key organisations and support services
Some hospitals provide specialist FGM services in African Well Woman
Clinics (AWWC). A list of these can be found here:
http://www.forwarduk.org.uk/resources/support/well-woman-clinics
Foreign and Commonwealth Office
If you are concerned that a British citizen may be taken overseas for the
purpose of FGM please contact the Foreign and Commonwealth Office
0207 008 1500
fgm@fco.gov.uk
You should also call Your local Children’s Services or Local Safeguarding Children’s Board
Your local Police Child Protection Unit
NSPCC
www.nspcc.org.uk
0808 800 5000
Foundation for Women’s Health Research and Development
(FORWARD )
www.forward.org.uk
E-mail: forward@forwarduk.org.uk
0208 960 4000
Metropolitan Police
Child Abuse Investigation Command / Project Azure
Anyone with information about children believed to be at risk of FGM, people
believed to be carrying out FGM in the London area, or any information
relating to offences of female genital mutilation is urged to contact the call the
information line on 020 7161 2888
http://www.met.police.uk/scd/specialist_units/fgm_reward.htm
Child Protection Helpline
(advice for adults worried about a child)
0808 800 5000
AFRUCA (Africans Unite Against Child Abuse)
www.afruca.org
Useful Resources
LSCB - FGM resource pack
Includes useful tools, posters, guidelines and links to specialist support
services
http://www.londonscb.gov.uk/files/2010/resources/fgm/london_fgm_resource_
pack.pdf
FGM National Working Group
An independent multidisciplinary group of health care professionals and
advisors.
Resources and dvd available
http://www.fgmnationalgroup.org/
For more details on this briefing please contact:
Joanna Sharpen
CYP Project Co-ordinator, AVA
Joanna.sharpen@avaproject.org.uk