Child protection must override patient confidentiality in FGM cases, and health workers should helps spot risk factors - including girls whose mothers and sisters have been cut
LONDON (Thomson Reuters Foundation) - Britain’s doctors and nurses must treat female genital mutilation (FGM) as child abuse and refer girls who have undergone ritual cutting to the police, leading medical organisations said on Monday.
The National Health Service (NHS) should also start systematically recording data on all FGM cases and share information with social services, schools and police, according to a major report drawn up by professional bodies representing midwives, nurses, gynaecologists, obstetricians and others.
FGM, which is often justified by practising communities on cultural or religious grounds, can cause serious long-term physical and psychological damage.
A 2007 study estimated 66,000 women and girls in England and Wales had undergone FGM and 23,000 girls were at risk, but experts say the figures have gone up. The ritual is mostly practised by communities originating from a swathe of African countries, including Somalia, Sudan, Eritrea, Egypt and Sierra Leone.
Janet Fyle, professional policy advisor at the Royal College of Midwives, which helped draw up the report, said it was time for everyone to stop hiding behind excuses.
“Even though FGM is child abuse, it has not been our priority because most people have felt that it’s a cultural thing and an exotic thing that people from different countries practise,” she said.
“Young girls turn up in accident and emergency at age 10 with (urinary) problems and nobody does anything, nobody asks what’s going on, and no one has been prosecuted.”
It is the first time a plan has been drawn up to systematically tackle FGM across the NHS.
“We are saying, do something about it now,” Fyle added. “That is what is groundbreaking – that we’ve all come together and said this must happen.”
The report also calls for the government to launch a nationwide hard-hitting publicity drive on FGM, similar to previous domestic abuse and HIV campaigns.
Public Health Minister Jane Ellison welcomed the report and said one of her priorities was to work on eradicating the “abhorrent practice”.
FGM has been illegal in Britain since 1985, but no one has ever been prosecuted. The proposed reforms come amid a concerted drive by police and prosecutors to address this failure.
In a forward to the report, Britain’s chief prosecutor Keir Starmer said health and social care professionals had a pivotal role to play in identifying and reporting cases.
PROTECTION OVERRIDES CONFIDENTIALITY
FGM, which is a way of controlling a girl’s or woman’s sexuality, involves the partial or total removal of external genitalia. In its most extreme form the vaginal opening is also sewn closed.
Some professionals are reluctant to intervene when they believe someone has had FGM or might be at risk because they are afraid of causing offence. Many also cite concerns about patient confidentiality. However, the report stresses that their duty to protect a child at risk overrides patient confidentiality.
One of the nine key recommendations is that all girls turning up at NHS services with signs of FGM must be considered potential victims of crime and referred to the police.
Efua Dorkenoo, FGM campaigner at rights group Equality Now, who helped draft the report, said it was “intolerable” that young girls were seeking treatment for FGM-related complications and no one was reporting these cases to police.
“That’s what they would normally do with any child abuse,” Dorkenoo said. “But they don’t do it with FGM because they continue to think it is just a cultural issue.”
She said it was too easy for clinicians to turn a blind eye, but they must now be held accountable.
The report says a girl born to a mother with FGM should be considered at "significant risk of harm” and monitored through the child protection system.
Notes should be put in the baby’s health records at birth. Social services should make a home visit, and information should be shared with the girl’s local doctor, health visitor and school nurse. Girls with older siblings who have undergone FGM should be considered at immediate risk.
The report urges schools in areas where practising communities live to include FGM in the curriculum.
Health workers who provide travel vaccinations to children from practising communities should also be alert. This is because girls are often taken abroad for FGM, even though this is an offence under British law.
Women who have undergone FGM are most likely to be identified through maternity services. The report says staff should inquire about when and where the FGM was performed and ask whether there are female children in the household. A referral to police should be considered.
The recommendations are also backed by professional organisations representing general practitioners, paediatricians and psychiatrists as well as FGM campaigners and survivors.
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