Catriona YoungThe UN policy on FGM states that “Violence against women and girls (VAWG) manifests in different forms. These include intimate partner violence, non-partner sexual violence, sexual exploitation and trafficking, and harmful practices such as female genital mutilation/cutting (FGM/C) and child, early and forced marriage, among others.’ [1]
FGM is a form of violence that affects as many as 10,000 girls aged under 15 (in England and Wales) but still goes largely underreported [2]. FGM is defined by the World Health Organisation (WHO) as “the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons” [3]. In essence, it refers to any harm or injury inflicted on female genitals without a medical indication. There are four types of FGM:
- Type 1 = partial/total removal of the clitoris
- Type 2 = partial/total removal of the clitoris and the inner labia (with or without removing the outer labia)
- Type 3 = narrowing of the vaginal opening and sealing over by repositing the labia
- Type 4 = any other harmful procedures for non-medical reasons such as piercing, pricking or incising the genital area
FGM can be a sensitive topic for many individuals and communities, often deeply rooted with other traditions that have been meaningful and precious for generations. However, in recent years there has been clear leadership from communities where FGM has been practised sharing how this form of violence has been used to control female sexuality, prove virginity and is driven by health beliefs that this practice will reduce sexual urges and therefore female promiscuity. Survivors of FGM have shared how women who don’t undergo the procedures can be at risk of stigma, shame and ultimately become ostracised from their communities. The religious scriptures of the main religions found across the world do not endorse the practice and in recent years there have been increased calls from leadership within communities to reject FGM practices.
Research has demonstrated this is not a neutral practice, associated with severe health risks including bleeding, infection, chronic pain particularly during intercourse, obstetric and labour complications as well as long-term psychological and mental health harm.
The Female Genital Mutilation Act 2003 means that FGM is illegal in England or Wales. The further amendments created by the Serious Crime Act 2015 mean it is also illegal to take a UK resident out of the UK to do the procedure.
This same amendment also requires all regulated health and social care professionals and teachers in England and Wales to make a report to the police as part of their professional duty if they:
- Are informed by a girl under 18 that an act of FGM has been carried out on her or
- Observe physical signs which appear to show that an act of FGM has been carried out on a girl under 18 and they have no reason to believe that the act was necessary for the girl’s physical or mental health or for purposes connected with labour or birth.
This is a legal requirement that must be communicated clearly to all frontline professionals.
As with other mandatory reporting, there are concerns amongst healthcare professionals that mandatory reporting to the police has driven those at risk or vulnerable to FGM from attending and receiving necessary healthcare. No evidence has been published evaluating whether this is an effective approach to reducing and preventing FGM.
As with those vulnerable to or experiencing human trafficking, it’s important for healthcare professionals to understand the “signs of FGM” and know how to support and safeguard their patients.
Some features that should raise concern of risk of FGM include:
- Acting differently after an absence from school
- From an FGM practising community
- Has relatives who’ve experienced FGM
- Finding it difficult to sit still/looking uncomfortable
There is a legal document which can be used to protect those girls who are at risk, which is known as a FGM Protection Order (FGMPO). This is not intended to criminalise families, but rather to support families to keep their daughters safe from FGM. The FGMPO can be requested by the girl at risk, the concerned local authority and any other person that the courts give permission (such as teachers, family members or the police). It can also be requested by the family of the girl, who may be under increased external pressure to have FGM performed on their daughter.
UNICEF [4] published a report to study the correlation between FGM and child marriage, a form of human trafficking. Whilst it was found that both practices find common roots in gender norms that devalue girls and prize virginity and ‘purity’, across different countries one practice tended to predominate or the other and girls would be more likely to experience one practice rather than both.
A previous study using Demographic and Health Surveys (DHS) in Burkina Faso, Ethiopia, The Gambia, Ivory Coast, Kenya and Nigeria did not identify a link between FGM practice and intimate partner violence [5]. Previous beliefs that policies should be created collectively may be made more effective in a targeted manner – policies and movements which come from communities affected.
In summary, many parallels can be drawn between FGM and other forms of abuse in the recognition and reporting of victims or people at risk. It’s important to understand the nuance and that different forms of abuse and violence require tailored, survivor-led, evidence-based responses. But that similar root causes may drive vulnerability to different forms of abuse and violence and therefore need to be addressed to prevent these harms. Most importantly, it’s important that frontline professionals are aware of the multiple forms of VAWG and feel empowered to know how to provide trauma-informed person-centred care and support and to safeguard.
This blog post is written by FGM Education Project, a group at the University of Aberdeen raising awareness about FGM, specifically in relation to the mandatory professional duty of reporting FGM or signs of FGM to improve safeguarding. If you wish to find more information please follow our social media accounts:
Twitter – https://twitter.com/EducationFgm
Instagram – https://www.instagram.com/fgm_education/
LinkedIn – https://www.linkedin.com/company/the-fgm-education-project/
(Language Comment – There are many different names used to describe FGM in different communities across the world. It’s important that the approach comes from grassroots and that the language is guided by those affected and depends who is speaking. There have also been objections to the term FGM because it’s found using the term ‘mutilation’ can sound quite accusing to those performing FGM which may create additional barriers. However, WHO has embraced the term for now so that there is consistent language for effective change to take place.)
References:
[1] UNFPA, UN Women, UNICEF (2017): Female genital mutilation/cutting and violence against women and girls: Strengthening the policy linkages between different forms of violence. Available: https://www.unwomen.org/en/digital-library/publications/2017/2/female-genital-mutilation-cutting-and-violence-against-women-and-girls Accessed: 18th May 2023
[2] Macfarlane, A. J. & Dorkenoo, E. (2015). Prevalence of Female Genital Mutilation in England and Wales: National and local estimates. London: City University London in association with Equality Now.
[3] WHO (2023). World Health Organisation Factsheets: Female Genital Mutilation. Available: https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation Accessed: 23rd April 2023.
[4] UNICEF (2021). UNICEF: Understanding the Relationship between Child Marriage and Female Genital Mutilation: A statistical overview of their co-occurrence and risk factors. Available: https://data.unicef.org/resources/understanding-the-relationship-between-child-marriage-and-fgm/ Accessed: 23rd April 2023.
[5] Janet A. Howard & Mhairi A. Gibson (2022) No relationship found between female genital cutting and intimate partner violence across six sub-Saharan African countries, Global Public Health, 17:11, 2704-2719.