Female Genital Mutilation (FGM), or cutting, is practice that has sadly affected at least 200 million young girls and women alive today across 30 countries (UN). FGM is the practice of altering or injuring the female genitalia for non-medical reasons. This can include the removal of the clitoris or labia, as well as the narrowing of the vagina, or other harmful procedures such as piercing or burning.
The United Nations website about their International Day of Zero Tolerance for Female Genital Mutilation 2016 said of FGM:
‘It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women and girls. The practice also violates their rights to health, security and physical integrity, their right to be free from torture and cruel, inhuman or degrading treatment, and their right to life when the procedure results in death.’
Combating FGM across the world has become a key focus of the United Nations, highlighted in its International Day of Zero Tolerance for Female Genital Mutilation, as well as its commitment to the eradication of the practice as part of the 2015 UN Global Goals. This year, November and December also see attention drawn to the practice of FGM as 25th November marked the International Day for the Elimination of Violence Against Women, and December 10th the annual Human Rights Day. In addition, the 16 days between the two events are known as the 16 Days of Activism Against Gender Based Violence which, alongside these awareness-raising campaigns, includes the eradication of FGM.
It is not just a focus of the United Nations: the British Government and the NHS have both emphasised FGM in their policies. It obviously comes under safeguarding guidelines, but was also included in the Serious Crime Act of 2015. Under this, clinicians have a mandatory duty to report cutting in under 18s, if they have seen it in examination or it has been reported by the victim themselves. It is a personal and a professional duty to report the case immediately.
There are, however, a number of issues with the mandatory reporting duty. Dr Sharon Raymond, safeguarding and FGM expert, author of Female Genital Mutilation: A handbook for professionals working in health, education, social care and the police, whilst praising the initiative, is also aware of a number of issues it poses. She believes clinicians can be unsure about what exactly what the mandatory reporting duty means, and what they need to do about it.
Perhaps the bigger issue is that the mandatory reporting duty can cause anxiety or fear in those who need help. Knowing the clinician has to report the case can prevent victims telling them about their experiences because they believe it could pose a risk to themselves, their families or their communities. This could even prevent victims seeing a clinician about other health problems because of the fear of FGM being diagnosed.
However, Dr Raymond believes that clinicians need to ask their patients about FGM when they consider that it may have been performed or that there could be a risk of FGM, rather than avoid the topic because of the possible fear it may cause. It is a bigger issue than the breakdown of a relationship between clinician and patient: not only can reporting the issue to a police help protect others, but clinicians are crucial in supporting patients. They are able to work to alleviate some of the complications, while both clinicians and the police can help prevent more girls suffer in the future from the practice.
Whilst the UK is taking steps to prevent FGM occurring within the country, and the UN is tackling the issue on a more global scale, and there is still much to be done. These initiatives, and the growing media focus upon the practice, are putting FGM into the public eye, but on an individual level there is much clinicians can do.
For clinicians who may deal with possible victims, who are perhaps unsure about the diagnosis, implications and management of FGM cases, then Dr Raymond’s handbook, Female Genital Mutilation: A handbook for professionals working in health, education, social care and the police covers these topics and more. It fills the possible gaps in knowledge and sums up the key issues clinicians can face. Find out more and order your copy here.