Last week I had an MMS message and when I logged in this is what I viewed:-
When I came to work in Ealing in 1997 I soon became aware that this was a common practise for many young Somali girls to have endured. It accounted for why they were reluctant to come for their cervical smear screening and in some cases why they were childless. It was not long before some of them approached me to be referred for corrective surgery. At that time Central Middlesex Hospital was in the throes of forming a team including the Gynaecologist Mr Harry Gordon and Mala Morjaria, specialist midwife practitioner to address this problem.
I was also aware of one of our patients a local solicitor was very passionately involved in campaigning for making it illegal and it is sad when I see her that I can’t share with her the more recent activity of abolishing this practise as she now has Alzheimer’s Dementia.
The precise origins of FGM are unknown, but the practice of FGM dates back 200 B.C although in many parts of West Africa, the practice began in the 19th or 20th century. Some scholars claim that it originated in the Nile Valley during the Pharaonic era and dates back to 400 years.
Recently when I spoke openly to a young Somalian patient about FGM to update me on how common it is today in our Somalian community. She was well informed and recognised that it was something her mother had come to realise was not an acceptable practise. However, she told me that her mother and her elder sister had had this done as it was considered an important ritual and a mother in Somali would be scorned upon if she did not arrange for it to be done and the girl would be derided by her peers. She was able to explain the different types of cutting and also was very cynical as to how it could be policed and people prosecuted for allowing it to be done.
However, it was good to hear how she was not only well informed, not afraid to speak out about it and adamant it should be a practise to be abandoned. It is educated girls like this with determined personalities we rely upon to educate future generations and drive to abolish FGM.
FGM is deeply embedded in local traditional belief systems for various reasons (Koso-Thomas 1987):
• Faithfulness: to ensure that women are virgins at marriage and remain faithful to their husbands .
• Chastity: to suppress female sexuality and to ensure chaste or monogamous behaviour (predominantly type 3, see below).
• Amongst those who travel in herds as a protection against rape
• Health: belief that it promotes cleanliness, improves fertility, and prevents both infant and maternal mortality.
• Religion: some practicing communities believe that FGM is a religious obligation, but there is no doctrinal basis for FGM . It is not stated in the Koran or Bible.
It is generally performed on girls aged between 4 and 12, although in some cultures it is practiced as early as a few days after birth; as late as just prior to marriage; during pregnancy or after the first birth. Girls may be cut alone, or with a group of peers from their community or village. The excisor can be a traditional birth attendant, a traditional practitioner or a health professional; typically, traditional elders (male barbers or female excisors) carry out the procedure, sometimes for pay. In some cases, it is not the remuneration but the prestige and power of the position that compels practitioners to continue. The practitioner may or may not have had health training, use anaesthesia, or sterilize the cutting instruments. Instruments used for the procedure include razor blades, glass, kitchen knives, sharp rocks, scissors, and scalpels.
Female Genital Mutilation (FGM) – also known as Female Circumcision (FC) or Female Genital Cutting (FGC) – involves the cutting or alteration of the female genitalia for social, rather than medical, reasons ac defined by the World Health Organisation. The term FC was widely used for many years to describe the practice; however, it has been largely abandoned as it implies a false analogy with male circumcision though various communities still use the term as a literal translation of their own languages.
FGM ‘comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female organs, whether for cultural or other non therapeutic reasons’.
The practice ranges from a symbolic cut, to the removal of all or part of a girl’s clitoris, to infibulation (sewing up the labia). Female Genital Mutilation or Cutting is therefore far more damaging and invasive than male circumcision.
Furthermore, while male circumcision is seen as affirming manhood, FGM is often perceived primarily as a means to curtail premarital sex and preserve virginity.
Immediate complications can include severe pain, shock, haemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue.
Long term complications include:-
*recurrent bladder and urinary tract infections;
*an increased risk of childbirth complications and newborn deaths;
*the need for later surgeries. For example, the FGM procedure that seals or narrows a vaginal opening (type 3 above) needs to be cut open later to allow for sexual intercourse and childbirth. Sometimes it is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing and repeated both immediate and long-term risks.
There are an estimated 30 countries where FGM is traditional practice, and members of communities from those countries that have emigrated practice it in their new homelands. The practice is common in many parts of Africa (in at least 28 African countries), as well as in some Asian and Arab Countries. Certain immigrant communities in Europe, Australia, Canada and the United States also engage in it. Countries have tried to ban the practice, with mixed success:-
Unicef estimates that more than 125 million girls and women have undergone the practice and that 30 million girls are at risk of it over the coming decade. In addition to Egypt, where 91 percent of women 15 to 49 have undergone the practice, countries with the highest percentages of women who have been cut include Somalia, at 98 percent; Guinea, at 96 percent; Djibouti, at 93 percent; Eritrea and Mali, at 89 percent; and Sierra Leone and Sudan, at 88 percent. Almost one in five young girls in sub-Saharan Africa are forced to endure FGM.
20,000 girls in the UK are at risk of FGM every year
Although the practise of FGM remains persistent in several countries in Africa and the Middle East teenage girls are now less likely to have been cut than older women in more than half of the 29 countries in Africa and the Middle East where the practice is concentrated. In Egypt, for example, where more women have been cut than in any other nation, survey data showed that 81 percent of 15- to 19-year-olds had undergone the practice, compared with 96 percent of women in their late 40s. Only a third of teenage Egyptian girls who were surveyed thought it should continue, compared with almost two-thirds of older women. Thankfully the practice is more widespread than it is popular, giving some hope that it will decline even more in the future;
A simple MMS message alerted Dr Livingston and myself to be more sensitive about this condition and to be proactive in understanding those women who have had FGM and to be vigilant if we suspect this is being carried out. If you want to support this campaign and read more about it by clicking the following link:-
Prohibition of Female Circumcision Act 1985 made genital mutilation illegal in the U.K although it allowed girls to be taken abroad and circumcised. A Private Members Bill was introduced by Ann Clwyd MP in 2003, and came into force in March 2004. (Mohammad 2005)
The Female Genital Mutilation Act 2003 makes it an offence for UK national or permanent UK resident to carry out FGM abroad, or to aid, abet, counsel or procure the carrying out of FGM abroad, even in countries where the practice may be legal. It also increases the maximum penalty for performing and procuring FGM from 5 to 14 years imprisonment.(Gordon 2005)
The Children’s Act (1989) states that every professional has a duty and responsibility to protect children, and that the welfare of children is PARAMOUNT.
As with any other suspected child abuse anyone can inform local Social Services or consult a health care professional for advise.
If you are worried that you or someone you know might be taken abroad for FGM, please call the police or local children’s services immediately. You can also ask a trusted adult such as a teacher or school nurse for advice first.
You can also obtain support from your Local Safeguarding Children Board (LSCB). The NSPCC provides a list of LSCBs on their website.
Non-urgent advice for British nationals abroad can be obtained from the Foreign Office helpline on 020 7008 1500.
Other organisations that can help are:
Helpline: 0800 1111
FGM helpline: 0808 028 3550
Metropolitan Police (Project Azure – FGM)
Helpline: 0207 161 2888
Helpline: 0800 555 111