edited by Miss Alice Barber & Dr Rachael Pickering
“All my life I’ve tried to think of a reason for my circumcision. If I could think of a reason, then perhaps I would be more able to accept what they’ve done to me. But I’ve never been able to find one. And the more I’ve thought about it, the angrier I’ve got.”
Introduction
The intentional alteration or injury of female genital organs for non-medical reasons, Female Genital Mutilation (FGM) is a globally recognised violation of women and girls human rights and health rights.[2,3] It is a form of child abuse as well as a discriminatory practice towards women.[4,5]
Techniques
FGM is most commonly performed on five to eight year olds but it is also done at any age from newborn to adulthood.[1] The ‘circumciser’ is usually an older woman.[1,5] Anaesthetic and sterile equipment are used but rarely, though in some countries it is performed by certain medical practitioners.[1,4]
Reasons
There are no health benefits to FGM[3,6] but many overlapping claims are used to support it: decreased female & increased male sexual desire, demonstration of faith,[7] economic factors,[8] family honour, marriage potential, rite of passage to womanhood, social acceptance and virginity prolongation.[1,5,9]
Ill-treatment
An estimated 200 million girls and women alive today have been cut.[3,10] Though it is predominantly in 30 African, Middle Eastern and Asian countries, asylum seeking and other forms of migration from these lands make FGM a global concern.[3]
FGM is a form of gender-based oppression or persecution. Asylum seeking women and girls who have undergone or are likely to be subjected to FGM may qualify for refugee status under the Convention and Protocol Relating to the Status of Refugees.[2,11]
FGM may be regarded as cruel, inhuman or degrading treatment and, under certain conditions (such as when performed by state-sanctioned healthcare professionals) it qualifies as sexual torture.[2,12] Women who have undergone FGM are also more likely to have experienced other acts of sexual and psychological torture.[13] They are also more likely to cite gender as a basis for persecution, compared with other torture survivors who have not been subjected to FGM.[2,13] This makes them a distinct group of torture survivors with specific physical and mental health needs.[13]
Identification
FGM, or being at risk of it, presents in a number of ways: a girl’s domestic circumstances or behaviour may arouse suspicion; a woman may self-identify; it may come to light during routine cervical smear or other health consultations; or it may be revealed during childbirth.[5]
Management
FGM is a form of child abuse and is illegal in at least 59 countries[14] including 26 of the 29 African and Middle Eastern states where it is most commonly carried out.[3] That said, prosecutions are rare.[14,15]
Many countries including the United Kingdom (UK) have also made it illegal to take a child abroad to receive FGM[16] and have passed other FGM-specific safeguarding laws; for example, in the UK it is thought that 23,000 girls under the age of 15 are at high risk of FGM[10] and UK healthcare professionals, teachers and social workers have a mandatory reporting duty if they come across such an at-risk child.[1]
Whichever way risk of FGM or FGM itself presents, it is important to be sensitive. An interpreter should be provided if necessary and communication should be non-judgmental and respectful.[17] Consideration should be given to other issues that the girl or woman may be facing, such as gender based violence or forced marriage.[18] Being in the asylum, benefits or care systems can exacerbate the psychological issues associated with FGM.[5] It is important to consider the whole person.
For girls and women who have been subjected to Type 3 FGM, surgical de-infibulation may be considered to enlarge the vaginal opening.[4] This is particularly recommended if the vaginal opening is too tight to permit normal urination, comfortable sexual intercourse, intimate examination and safe vaginal delivery.[4,19] If a woman is pregnant or trying to conceive she should ideally be offered specialist antenatal care including possible de-infibulation and consideration of potential future child protection concerns.[19] In many countries including the UK it is illegal to
re-infibulate a woman after childbirth.[16,19]
Support
It is also important for victims to be offered psychological support.[4] Having to repeat stories of FGM and having repeated examinations are known to compound trauma[5] and so, wherever it is available, victims should be referred directly to specialist multidisciplinary specialist care teams.[19] Community support and education groups are additional valuable sources of support.[4]
[1] FORWARD. Female Genital Mutilation Frequently Asked Questions: A Campaigner’s Guide for Young People. London, UK: FORWARD, 2012
Available from: https://bit.ly/35StEPA [Accessed 30th October 2020]
[2] United Nations High Commissioner for Refugees (UNHCR). Guidance note on refugee claims relating to female genital mutilation. Geneva, Switzerland: UNHCR, 2009
Available from: https://bit.ly/3ei6kyD [Accessed 30th October 2020]
[3] World Health Organisation. Female Genital Mutilation. Fact Sheets. Geneva, Switzerland: World Health Organisation, 2020
Available from: https://bit.ly/3jFZi7N [Accessed 30th October 2020]
[4] World Health Organisation. WHO guidelines on the management of health complications from female genital mutilation. Geneva, Switzerland: World Health Organisation, 2016
Available from: https://bit.ly/2JiKqzP [Accessed 30th October 2020]
[5] Scottish Government. FGM: Responding to Female Genital Mutilation in Scotland: Multi-Agency Guidance. Scotland: Scottish Government, 2017
Available from: https://bit.ly/2HLD0EG [Accessed 30th October 2020]
[6] Scottish Government. FGM - A Statement Opposing Female Genital Mutilation. Scotland: Scottish Government, 2015
Available from: https://bit.ly/37UrUbp [Accessed 30th October 2020]
[7] Some people practice FGM as a demonstration of faith. However, FGM is not recommended by any religion or in any religious text.
[8] Circumcisers generate their income from performing FGM. The FGM celebration provides gifts and money to a girl and her family. It is also believed that as FGM ensures a girl’s virginity, a man will be more willing to pay a higher bridal price (that is, money paid to her parents) in order to marry her.
[9] Daughters of Eve. What is Female Genital Mutilation (FGM)? UK: Daughters of Eve, 1999
Available from: https://bit.ly/34FbbH4 [Accessed 30th September 2020]
[10] UNICEF. Female Genital Mutilation/Cutting: A global concern. New York, USA: UNICEF, 2016
Available from: https://uni.cf/2HPnasT [Accessed 30th October 2020]
[11] United Nations Refugee Agency. Convention and Protocol Relating to the Status of Refugees: United Nations General Assembly Resolution 429 (V). Geneva, Switzerland: UN, 1951
Available from: https://bit.ly/3oDlEe9 [Accessed 30th October 2020]
[12] Council of Europe. Female Genital Mutilation and Forced Marriage. Strasbourg, France: Council of Europe, 2017
Available from: https://bit.ly/2TRidCt [Accessed 30th October 2020]
[13] Akinsulure-Smith AM, Chu T. Exploring Female Genital Cutting Among Survivors of Torture. J Immigr Minor Health. 2017;19(3):769-773
[14] Equality Now. FGM and the Law Around the World. New York, USA: Equality Now, 2019
Available from: https://bit.ly/3oG6jJJ [Accessed 30th October]
[15] BBC News World Service. What is FGM, where does it happen and why? London, UK: BBC, 2019
Available from: https://bbc.in/37VNzQr [Accessed 30th October 2020]
[16] UK Government. Female Genital Mutilation Act 2003 Chapter 31. London, UK: UK Government, 2003
Available from: https://bit.ly/3oJKMQr [Accessed 30th October 2020]
[17] Royal College of General Practitioners. Female Genital Mutilation: A clinical approach for GPs. London, UK: Royal College of General Practitioners, 2020
Available from: https://bit.ly/3jKFr7D [Accessed 30th October 2020]
[18] FGM Aware. FGM Indicators of Risk. Glasgow, Scotland: FGM Aware, 2016
Available from: https://bit.ly/35Nb8YZ [Accessed 30th October 2020]
[19] Royal College of Obstetricians and Gynaecologists. Female Genital Mutilation and its Management: Green-top Guideline No. 53. London, UK: Royal College of Obstetricians and Gynaecologists, 2015
Available from: https://bit.ly/31ZrjkN [Accessed 30th October 2020]