A coalition of female genital mutilation (FGM) survivors, medical professionals, academics, think-tanks, and other organisations called ACTION:FGM has sent a manifesto to the UK government today demanding it adopt a series of recommendations including the mandatory implementation of FGM screening questions by all GPs.
Today is the International Day of Zero Tolerance for FGM and this year's theme is 'Unleashing Youth Power: One decade of accelerating actions for zero female genital mutilation'. The aim is to mobilise younger populations to help amplify and support the efforts to eliminate harmful practices including FGM.
According to Action Aid, FGM, also known as female genital cutting and female circumcision, is the partial or full cutting of a girl’s clitoris and labia, for non-medical reasons, nearly always on girls between infancy and age 15 years. Although the practice has been around for more than a thousand years, the United Nations is striving for its full eradication by 2030.
In 2020 alone, there are 4.1 million girls around the world at risk of undergoing FGM including tens of thousands in the UK. This is why ACTION:FGM has launched a public campaign to tackle FGM and honour-based abuse in the UK.
- GPs must not shy away from tackling female genital mutilation
- GPs face FGM challenge
- New e-network for midwives on FGM issues
Health risks of FGM
The health risks associated with FGM include pain and repeated infections as well as blood loss from the procedure itself which can be fatal. It can also cause incontinence, cysts and abscesses and lead to mental health problems.
One study found that almost 80% of the women who had undergone FGM met criteria for affective or anxiety disorders, with a high rate (30.4%) of post-traumatic stress disorder (PTSD). The researchers also stated that the high rate of PTSD of more than 30% in the FGM group compares to the rate of PTSD of early childhood abuse (which ranges between 30% and 50%).
It concluded that FGM is “likely to cause various emotional disturbances, forging the way to psychiatric disorders, especially PTSD”.1
Mandatory screening by all GPs
GPs are usually the first point of contact for the vast majority of patients in the UK and are in the unique position to identify victims. The most significant risk factors that indicate that patients may be at risk of FGM are coming from a community known to practice FGM and having a mother or sister that has been affected.
The Royal College of GPs, however, have released a statement to say that there is no evidence that screening for FGM works nor has there been any analysis of the potential and unintended harms this could lead to such as deterring women from visiting their doctor, leading parents of girls who have been victims of FGM to potentially avoid all contact with surgeries.
It does not therefore support that recommendation from ACTION: FGM that GPs and other healthcare professionals working in general practice carry out mandatory screening.
Professor Martin Marshall, Chair of the Royal College of GPs, said: "FGM is a horrific crime that affects women and girls around the world, including here in the UK, with serious long-term and in some cases fatal implications. It's appalling that it is still happening in the 21st century.
"This is not to say that GPs do not have a role in identifying women and girls who have had or who are at risk of FGM and it remains vital that GPs are aware of the symptoms, legal and safeguarding protocols and support networks that are available for these patients."
So what can be done to tackle FGM in the UK?
Healthcare professionals have valid concerns regarding the potential repercussions of the mandatory reporting duty, including the negative impact it may have on their relationships with patients and their families, and the potential consequences of a report for children and their families, such as children being taken into care.
Yet Dr Sharon Raymond, Named GP for Safeguarding Children for two London CGCs, says that the safety of the child or young adult will always be of paramount importance to GPs despite these concerns.
She said: "Healthcare professionals manage the needs of many patients suffering with the complications of FGM, both physical and psychological, and, as such, are well placed to identify FGM, and make a mandatory report of this all too often hidden crime, with a view to contributing to the goal of one day ending this form of abuse against women and girls."
- Further reading. Female Genital Mutilation: A handbook for professionals working in health, education, social care and the police
In June last year the Royal College of Midwives (RCM) launched an e-network funded by the Department of Health and NHS England for specialist midwives and other professionals working on the frontline to tackle FGM and support survivors. It created a virtual forum of support where relevant resources can be accessed and shared, including links to appropriate data on FGM.
Janet Fyle Professional Policy Advisor at the RCM said: “No local authority area in England and Wales is untouched by FGM. Many girls and women here in the UK continue to be at risk of FGM. It is vital we continue to raise public awareness of the negative impact on the individuals’ life, the illegality of this practice and the consequences of carrying out FGM on a girl or woman.
“It’s important that the safeguarding systems currently in place for protecting girls from FGM are understood by all those who work or interact with women and children particularly those in health, social care and education. We must also support key professionals and activists who work together to tackle FGM and the issues that surround it."
1. Behrendt A, Moritz S. Posttraumatic stress disorder and memory problems after female genital mutilation. American Journal of Psychiatry 2005; 162:1000-1002
Alison Bloomer is managing editor of British Journal of Family Medicine