Saturday, 28 November 2015

Female Genital Mutilation: A Hideous Crime (29 November 2015)

Carol McCormick, FGM specialist midwife


Female Genital Mutilation (FGM) sometimes referred to as female genital cutting or female circumcision is the cultural practice of cutting off parts of the external female genitalia, which is usually performed on very young girls. It is classed as torture by the World Health Organisation (2104) and is a harmful practice that can cause significant morbidity and even mortality. Evidence suggest that approximately 100-140 million girls/ women, across the world, have been subjected to this abusive practice and that around 3.3 million girls are at risk of FGM each year (World Health Organisation, 2012). It is against the law in many countries including the UK (Creighton & Liao 2013) where it carries a penalty of up to 14 years imprisonment. The short term physical and psychological consequences of FGM include haemorrhage, flashbacks and even death. In the UK, we mainly see the long term consequences such as chronic infection, but the most common long term physical consequence of FGM is difficulties in childbirth (Berg & Underland 2013). For years the front line staff on labour wards have been seeing increasing numbers of women with FGM attending in childbirth. These staff are often ill equipped and not trained to deal with the situation to the detriment of women.

In recent years many initiatives have been developed to educate and support staff and improve the care of childbearing women who have undergone FGM and to protect their female children from the practice.

At present we do not know the numbers of girls and women in the UK who have undergone FGM so a large initial part of addressing FGM in the UK is to look at the demography/prevalence of the practice. We now have professional duty to complete an FGM Enhanced Dataset Information Standard for all women/girls seen with FGM. This is to support the national FGM prevention programme. The health care professional has to access the database of the Health and Social Care Information Centre (HSCIC) Information Centre. As the information to be submitted is patient identifiable some practitioners have been reluctant to embrace this and have not yet begun to comply, leaving themselves vulnerable to professional actions being taken from their college or the Nursing and Midwifery Council (NMC) or General Medical Council (GMC). In addition to mandatory reporting there is also new legislation that allows UK residents who 'habitually abide' in the UK to be prosecuted under the Serious Crime Act 2015, the act also legislates to protect the anonymity of victims of FGM by publications that could identify them. Section 3A of the Act makes it an offence for anyone with parental responsibility to fail to protect a girl from FGM and section 5A provides a framework to protect a girl at risk of FGM. For health care professionals under section 5B of this Act it is now a statutory duty to notify the police if they discover the act of FGM has been performed on a girl who is under 18 years of age.
FGM map

With the aim of zero tolerance of FGM globally we must take the initial steps of identifying the breadth of this practice if we are to aim our limited resources where it can make the most impact in preventing our global children undergoing this harmful cultural practice. We CAN end FGM if commit to tackle it as interdisciplinary team.



Carol McCormick is a nurse and graduate midwife with the diploma in tropical medicine and postgraduate law degree who also works as an expert witness. Whilst working in the Middle East and Africa she gained hands-on experience in dealing with FGM. On return to the UK she worked in Nottingham as the consultant midwife in intrapartum care. She has run the female genital mutilation service in Nottingham for the past 14 years.



References


Berg RC, Underland V (2013) The obstetric consequences of female genital mutilation/cutting: a systematic review and meta-analysis. Obstetrics and gynecology International Article ID 496564

Creighton, S. M., & Liao, L. M. (2013). Tackling female genital mutilation in the UK. BMJ 347:f7150

World Health Organization (2014). Female Genital Mutilation. www.who.int/topics/female_genital_mutilation/ (Accessed 25 November 2015)

World Health Organization (2012). Female Genital Mutilation. Understanding and Addressing Violence Against Women, World Health Organization, Geneva, Switzerland available at http://apps.who.int/iris/bitstream/10665/77428/1/WHO_RHR_12.41_eng.pdf (Accessed 25 November 2015)






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