FGMWe spoke with Dr Sharon Raymond GP, the author of Female Genital Mutilation; A handbook for professionals working in health, education, social care and the policeto ask her about her work as a GP with a specialist interest in preventing the practice of FGM and how health care professionals can help combat the illegal practise.

Sharon explained to us that after years of unreported cases and healthcare professionals not knowing where to turn or what to do when treating a female patient who had been a victim of female genital mutilation, FGM is now high up on the government’s agenda and a major priority for NHS England.

Previously statistics on cases of FGM were just estimates, but the Department of Health initiative to gather vital data on how many women have been subjected to FGM means we will now have a clearer picture of the number of women affected.

Awareness of FGM in the UK was brought to the forefront of the national media by the Girl Summit, co-hosted by UNICEF the summit took place on 22 July 2014 in London. The campaign aims to mobilise domestic and international efforts to end female genital mutilation (FGM) and child, early and forced marriage within a generation.

It is very hard to track cases of FGM and people are still nervous of offending people and their cultures. Within communities it is seen as a ‘rite of passage’ and important for community acceptance.
 

Why is FGM so difficult to prove?


• relies on evidence from children
• victims may not want to turn against family members
• fear that their community will turn against them
• FGM survivors may not be aware that they have undergone FGM as it was done at a young age.
 

Belief systems


Before we can combat FGM we must first understand why families carry out FGM. There is a very strong belief system around it and often families believe FGM is crucial in order for their daughter to have a ‘good’ life and be accepted as a wife. To stand up and speak out against FGM could lead to a girl/woman being excluded: it could lead to her/her family losing their social standing and position in the community. It can even lead to some socio-economic implications too, for example, a girl/woman may lose her home or income.
 

Men need to be made aware


It is vital that awareness campaigns speak to males within the community as the women are often subjected to FGM due to pressure exerted by men. Men need to understand that FGM is illegal and in the worst cases fatal. There are serious health consequences of FGM, such as infection, bleeding, infertility, problems in child birth, problems with intimate relationships and potentially a lifetime of pain both physical and psychological.

All this communication must be done in a very clear, consistent and sensitive way so as not to alienate communities, if done properly it can help to convert people within the community to become ambassadors against FGM.

Current FGM outreach projects in the UK aim to raise awareness of the dangers of FGM and ensure communities understand it is illegal. Survivors’ of FGM are speaking up to the community about their experiences and the long-term physical and psychological effects of the abuse.

In England it’s a criminal offence to commit FGM on any UK citizen and leaders are now looking at the best ways to support clinicians on the frontline who come into contact with abused girls. FGM is an abuse of women and girls and just like any other form of abuse it needs a unique type of support and safeguarding strategy.

The government’s finally listening to what needs to be done about FGM; money is now being invested; training courses for healthcare professionals are being rolled out; and there are recommendations to make FGM a part of mandatory safeguarding training.

 

 

We strongly suspect that ‘cutting’ takes place in the UK. To take a child abroad for FGM is very expensive, often the ceremony is followed by a family celebration. It is unlikely that most families in the UK can afford to take their whole family abroad and pay for FGM. It is much more likely that it is happening within the UK and that communities have their own designated ‘cutters’ who are subjecting girls to this abuse.

The three Cs and the importance of translation (copyrighted to Dr. Raymond)


As a GP it is really important that if a patient presents with symptoms of for example, recurrent urinary tract infections that the doctor takes into account where the patient, or her parents, are from and sensitively investigates if it could be as a result of FGM. The Department of Health have published vital colloquial terms for FGM in 13 languages in their document Multi-Agency Practice Guidelines: Female Genital Mutilation, which provides advice and support to frontline professionals who have responsibilities to safeguard children against FGM.

 

To help train and raise awareness of FGM amongst time limited healthcare professionals (HCPs), I have devised an easy tool to risk assess for FGM:

The three Cs:


Community. Do you come from a community where FGM is carried out? Women and girls from certain countries are much more likely to have been subjected to FGM.

Cut. Have you been cut or has anyone you know been cut? (family members, friends)

Cut. Do you plan to have your daughter(s) cut?

Plans are underway to inform clinicians of this tool by means of producing a laminated guide, which will also include a detailed map on the guide showing where FGM is prevalent and a list of colloquial terms for FGM.

 

 

Support for victims of FGM


There is support out there for victims of FGM, which follows the same principals of any child abuse support. Victims are offered counselling and support for problems such as post-traumatic stress disorder. However, a centralised strategy for dealing with the specific abuse of FGM and victim support is being formulated. But for now at least there are numerous examples of medical and psychological care and support for FGM survivors across the country , as well as several voluntary organisations who offer specialist support, such as Southall Black Sisters, NSPCC and Forward.

Dr Sharon Raymond MBBS MRCGP is a member of NHS England Female Genital Mutilation (FGM) steering committee, named GP for Safeguarding Children, Croydon CCG and Medical Lead for North West London, Care UK.


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