Female Genital Mutilation: the difference between diagnosis and convictions in the UK

By Kuheli Biswas

One Friday evening, while visiting the GP for a follow-up check-up, I was asked to wait. While waiting, I came across a bundle of pamphlets on vaccines, common diseases, hygiene, holiday list and pages after pages of guidance for pregnant women stuck on the wall, noticeboard and neatly kept on a table. Underneath all that, there was only one page from NHS referring to the harmful health consequence of Female genital mutilation (FGM) or Female Genital circumcision (FGC). Half hidden, yet the significance of the information was a powerful reminder that even in the UK, where FGM is criminalised, the practice is far from being eradicated. In fact, according to the United Nations, about 200 million women live with FGM.

NHS estimates that over 65000 children under the age of 13 are at risk of FGM. Even though the Female Genital Mutilation Act of 2003 completely forbids any form of mutilation performed on female genitalia, in the UK it still remains a prevalent problem as in some cultures it holds profound significance. The UK authorities in such scenarios advise the police: “Officers should be culturally and faith aware in their dealings with victims of FGM, but should never hesitate to take appropriate and effective action to enforce the law and/or safeguard children.”

Most of the FGM cases in the UK are done by non-medical practitioners and can prove extremely harmful for the victim. In such scenarios, the female undergoing the procedure can experience severe pain, infection, haemorrhage, surrounding tissue injury, shock and/or death.

What does the data say?

Under Freedom of Information, I asked 43 police forces of England and Wales to provide data on numbers of FGM cases registered by them between 2015 and 2019. The recent figures from the England and Wales police forces show that FGM is just a part of the problem. Most of the time, the survivors are also victims of honour and gender-based violence, suppression of sexuality, or forced marriages. Data provided by the West Midlands police show that FGM (as crime and non-crime) has been part of 605 cases between 2015 and 2019 in Child abduction by a parent, assault and sexual assault offences.

In Derbyshire, even though zero cases were reported in the last five years, the figure presented by the local police authorities state that 50 cases of ‘at-risk of FGM’ concerns were registered. Dorset police made zero arrests even though eight cases were registered. Merseyside, Bedfordshire and Humberside had a higher number of cases registered, whereas districts such as Derbyshire and Wiltshire had almost zero registered FGM cases. Overall, 13 police forces across England received as little as 157 cases over the years, with only a few convictions. Only a few cases end up in an arrest as most of these cases lack a suspect or proper evidence against a perpetrator for a successful warrant. Sometimes it is hard to establish a suspect in cases where FGM was conducted in another country or if the perpetrator does not reside in the UK.

But, in the last five years, the NHS recorded about 25000 new cases, with the highest number being reported in London. These cases include all the four types classified by WHO and the NHS depending on the severity of the mutilation — Clitorectomy, excision, infibulation and others.

The majority of the cases reported to NHS generally come from obstetrics, midwives, gynaecologists, diagnostic imaging services and genitourinary medicine clinics. Now, combine these figures with already existing cases. Alison Macfarlane from City University London, in 2011, estimates that over 103,000 women with FGM were living in England, which has grown exponentially over the years given the current NHS’s data of new cases.

When these data are compared with the Police figures, the stark difference only highlights the under-reporting factors and the prevalence of the crime. A major cause of this difference is underreporting among asylum seekers and minority ethnic communities as it opens them up to fear and risk of deportation. Human Rights lawyer, Charlotte Proudman wrote in the Guardian: “On the one hand it postures about its commitment to prosecute minority ethnic parents in the UK over FGM, yet on the other hand it deports women and girls at risk of mutilation abroad.” She further adds: “If the government was genuinely committed to protecting women and girls from FGM, it would be concerned with them being cut overseas.”

Even though the new case records still remain high in England and the collective data higher, there is a fall in the number of cases reported by doctors. The reason for this downward trend in England can be the exclusion of cosmetic surgeries done by doctors and greater awareness created by NGOs. The Royal College of Obstetrician and Gynaecology condemns the act by stating: “FGM is practised for a variety of complex reasons, usually in the belief that it is beneficial for the girl. It has no health benefits and harms girls and women in many ways.” And has created a proper guideline and an FGM Task Force to prevent doctors from using their position to violate Human Rights law. Under the guidelines, a surgeon can only perform cosmetic surgery if it is absolutely necessary for the physical and mental health of the woman. Other facilities such as FGM Protection Order and amended FGM Act of 2015 helps at-risk children and women as well as people with FGM file for protection anonymously and without any charge. The order helps girls and women restrict contact with perpetrators as well as restrict them from being taken to another country where FGM is widespread. Prevention of a crime is a huge factor in reducing the number of cases over the years.

What are the complexities Police face while preventing FGM?

In many ways, the difficulty of preventing the risk of FGM in the UK comes from people’s religious beliefs and cultural significance. It is child abuse and causes major physical and emotional distress to a child’s life. Anthropologist Bettina Shelly-Duncan of Washington University explained in an interview with The Atlantic: “We believe that bodies are natural and perfect. Not everybody believes that. Some people in Africa believe that bodies are androgynous and that all male and female bodies contain male and female parts. So a man’s foreskin is a female part. And for a female, the covering of the clitoris is a male part. The idea of becoming a wholly formed female includes being cut — having any part that is somewhat male-like removed from the body.”

Hadas, who moved to the UK from Eretria, shared her story of having gone through FGM with the NGO Childline: “In my culture, it’s believed that when the vagina is cut, the desire to have sex is cut as well. My culture believes that sex is only something a woman does with her husband to have children.

“Most people in Eritrea think that if a girl is cut, she will grow up to be a good girl — that she will not bring shame on her family and she will marry well. If a girl is not cut, they think she will grow up to be a ‘slut’ — a girl who thinks about sex and will not be satisfied by one man.

“The first time I heard about cutting was from overhearing my parents fight about it, which they did throughout my childhood. I am not angry with my mother for taking me to get cut. My mother is a traditional person and hasn’t been educated about it. She thought she was doing the best for me.

“It is a disgusting practice that many people only do because they believe that the stories around it are true and they are uneducated. I do not think that people really understand the problems which female genital mutilation can cause for girls. I didn’t understand myself until I was told.

“I look ahead and see problems in my future with any relationships that I choose to have because I’m afraid that sex will hurt. My periods are painful too and I’ve been told it will be very painful to give birth.

A 14-year-old girl who moved to the UK recounted her story of undergoing FGM at the age of six to the national charity Brook: “The woman who cut us was my grandmother’s sister — and she was going to cut us in a tent near a huge tree. They used ropes to tie our legs apart and there were lots and lots of girls there. I could hear screaming, lots of horrible screaming and there was so much blood. Girls were crying.

“My sister went first, they cut her then they took her somewhere. I heard she fainted. My grandmother’s sister was cutting so many girls and when my sister had been done, she told her to stand just outside, and the blood was running down her legs, then she fainted. My grandmother was screaming at her sister — asking her how she could do this to her grandchildren. She was terrified that my sister would die. But my great aunt insisted, and they said it was my turn. I ran away — I ran as fast as I could but they sent boys after me and they caught me. They took my legs and my arms and carried me back. One of them was my older brother — he helped carry me back to the cutter.

“They tied me down, I was fighting as hard as I could, but they were stronger. I was screaming. The old woman, my great aunt, used a razor blade — it was clean and new, but there was no anaesthetic when she cut me. I have no memory at all of her cutting me — it’s blank. But then another woman came, she was from a different city, and she gave me an injection before they stitched me up. They tied my legs together the whole way down so I couldn’t open my legs, I was like that for three or four weeks.

Most children and women with FGM had to deal with painful procedures conducted in unsanitary places and without any proper medication. In long term, FGM leads to depression, anxiety, PTSD, painful periods, reduced libido among women and girls. It also increases complications during childbirth and urinatory problems among others.

But all hopes aren’t lost. In 2019, a mother of a three-year-old from Uganda was convicted for performing FGM on her daughter. Commander Ivan Balhatchet of National Police Chiefs’ Council (NPCC) heading FGM, told The Guardian: “We have always been clear that prosecutions alone will not stop this abuse, however, this guilty verdict sends a strong message that police will make every effort possible to pursue those committing this heinous crime.”

More convictions such as this would encourage others to come forward to police and social services, which ultimately would help prevent more cases, create a task force to prevent FGM and education plan as well as set a strong example for survivors.

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