FGM: Torture not Culture Faye Macrory MBE Consultant Midwife Central Manchester University Hospitals NHS Foundation Trust (CMFT) & Alison Byrne Specialist.

FGM: Torture not Culture

Faye Macrory MBEConsultant Midwife

Central Manchester University Hospitals NHS Foundation Trust (CMFT)

&

Alison ByrneSpecialist Midwife (FGM)

Heart of England NHS Foundation Trust

the starting point……………

FGM is the manifestation of gender inequality that is entrenched in social, economic and political structures.

FGM is a form of violence against women and girls.

(WHO 2008)

The FGM Act (2003)

It is an offence to excise, infibulate or otherwise mutilate the whole or any part of the labia majora, labia minora or clitoris of another person for non medical reasons, or to aid, abet council or procure any of these acts on that person’s own body. It is also an offence to take a child out of the Uk for that purpose or to arrange it. The penalty is up to 14 years imprisonment.

Where FGM is practised: communities at risk

Africa: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d’Ivoire, Dijibouti, Egypt, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Togo, Uganda, United Republic of Tanzania.Also:Iran, Iraq, Malaysia, Saudi Arabia

Classification of FGM

FGM (also called cutting) comprises all procedures that

involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non medical reasons

(WHO 2008)

Terms used: e.g. sunna, kakia, bundu, tara, tahur:- meaning purification

without

Type 1: Clitoridectomy: partial or total removal of the clitoris

Type 2: Excision: partial or total removal of the clitoris and the labia minora with or without excision of the labia majora

Type 3: Infibulation: narrowing of the vaginal opening through the creation of a covering seal, repositioning outer and inner labia with, or without removal of the clitoris

Type 4:All other harmful procedures to the female genitalia for non-medical purposes e.g. • pricking • piercing• incising• scraping• cauterizing the genital area

?? and what about labioplasty/ cosmetic surgery??

Why the practice continues:

• custom and tradition• mistaken belief that FGM is a religious

requirement• preservation of virginity/chastity• social advantage, especially for marriage• enhancing fertility• hygiene and cleanliness• increasing male sexual pleasure• family honour• sense of belonging to a group vs fear of social

exclusion (WHO 2008)

Short term complications of FGM

• haemorrhage• shock• acute urinary retention• damage to other organs• infection• failure to heal• death

Long term complications of FGM:

• difficulties passing urine• urinary tract infection/HIV, Hep.B• menstruation difficulties• chronic pelvic infection• infertility• vulva abscess/cyst/calculus/neuroma• keloid scarring/fistula• increased risk during delivery e.g. perineal

trauma, PPH and perinatal death• Sexual, psychological and psychosexual

difficulties

Psychological impact of FGM

• physical effects well documented but emotional effects remain limited in the research.

• psychological counselling may lead to feelings of betrayal by parents, incompleteness and anger, overwhelming trauma and the long lasting emotional damage and implications from FGM and of suffering in silence.

• psychosocial implications of NOT undergoing FGM are also considerable. Therapeutic interventions need to take into account deep rooted beliefs into the practice of FGM and the cultural and social pressures women from practising communities are likely to experience.

(Mulongo, P. et al. 2014)

NESTAC (New Step for African Community 2012) and Support our Sisters (SOS)

• Aim to add to the body of knowledge re the emotional effects of FGM & appropriate interventions

• 3 year collaborative research project under Salford University Well-Being Programme

• a community based programme mainly supporting refugees & asylum seekers and attending to their socio-cultural needs

• the development of a specialized service (SOS) for cognitive & emotional support

• 3 drop-in clinics ( Rochdale, Lower Broughton and St. Mary’s)

• accredited training for peer mentors

Health

Health professionals have many opportunities to identify women affected and girls at risk particularly in:

• A&E/ED• maternity and gynaecology• female surgery• urology/continence team• SARC, GUM, CASH• GPs, HVs, School Nurses

CMFT action plan

2 key aspects in managing FGM:• provision of sensitive & appropriate services to

all women identified with FGM• Safeguarding infants and girls at risk of FGM

3 elements:• data collection• education & awareness• safeguarding

Completing the form online

• form combines 4 forms from original DH documents so minimises repetitive data capture

• to be used for all new FGM patients

• details submitted to database - automatically amends duplication registrations made under same case note number

• all future contacts recorded on PAS and CMIS automatically identified to satisfy requirement to report on ongoing active caseloads of contacts with known FGM

patients

What did we need to do before going live?

• addition of instruction sheet to data collection form, including SARC & GUM

• agree when & how information is shared with Safeguarding

• implement a sign-off and assurance process before monthly data is shared externally

• add link to Intranet for easy access to online form

• communicate with staff and raise awareness e.g. via WWN

Safeguarding Guidance

• identifying risks

• pathways

• response from CS

• sensitivities and complexities of FGM

What’s going on…….?

• community based prevention – what works?

• multi-agency collaboration

• nationally

• internationally

CASE STUDY 1

• A woman presents needing a vaginal/speculum examination and is found to have FGM. She is extremely distressed during the examination.

What should you do?

CASE STUDY 2

• A pregnant woman discloses at booking that her 1st child born in Somalia in 1997 has had FGM.

What course of action would you take?

CASE STUDY 3

• Following disclosure of FGM a woman asks you where she can get FGM performed in this country for her daughters.

What will your response be?

CASE STUDY 4

• Police officers request that a child is physically examined as there has been an allegation that the child is at risk of FGM.

What would you do?

Useful websites

• www.fgmnationalgroup.org• www.rcm.org.uk• www.who.int/• www.amnesty.org.uk• www.fgmnetwork.org• www.equalitynow.org• www.dofeve.org• www.nspcc.org.uk

• www.endthefear.co.uk/practitioners• www.afruca.org • www.forwarduk.org.uk• www.nestac.org• www.fgmelearning.co.uk• http://

greatermanchesterscb.proceduresonline.com/chapters/p_fgm.html

• House of Commons, Home Affairs Committee: FGM: the case for a a national action plan 2014-2015

• http://www.hscic.gov.uk/catalogue/PUB15711

FGM is child abuse

Call the NSPCC helpline

0800 028 3550

or

email: [email protected]

never forget

It’s torture……….

not culture…….

In the memory and admiration of:

Efua Dorkenoo

1949 - 2014

Cutting the Rose: FGM Practice & Prevention (1994)