In 2015 a new law came into effect which decreed that all regulated health and social care professionals and teachers in England and Wales have a mandatory duty to report cases of female genital mutilation (FGM) in under 18s which they have identified in the course of their professional work to the police.
This adds to a tier of law specifically in place to record data on women and girls with FGM. But are these policies a futile political gesture that stigmatize FGM- affected cultures and compromise a trusting relationship between professionals and women living with the consequences of FGM?
In 2014 the Department of Health mandated the monthly collection of prevalence data on women who had been previously identified as having had FGM, as well as newly identified victims. This was replaced in April 2015, by the FGM enhanced dataset. Clinicians in England are now required to record a long list of information on any patient with FGM, including her name and her NHS number, and send this data quarterly to the Health and Social Care Information Centre (HSCIC).
The goal of the enhanced dataset is to record accurate data on women and girls found to have had FGM. On the face of it, there are good reasons for collecting accurate data. Up until now the methods for assessing numbers of FGM-affected women and girls varied wildly, and have been based on unreliable surveys, interviews and extrapolations from other sets of estimates such as numbers of women from FGM-practicing countries applying for asylum. Marge Berer, the founding editor of the Reproductive Health Matters journal observes that ‘none of these estimates were derived from a bona fide epidemiological study and should never have been accepted and treated by officials, the media or campaigners as if they were.’
But both the enhanced data set and the mandatory reporting of under 18s come at considerable cost. First is the extent to which the rights of patients are being violated by the data collection. In Berer’s blog she recalls the controversy when named data collection was proposed to identify people living with HIV. The proposal was identified as a violation of privacy and medical confidentiality and rejected. With the FGM laws, affected women have been given no choice. And Berer observes that they do not have the social and political clout, or the public support to challenge Government, as people with HIV were able to do previously.
Another issue is, what exactly counts as FGM and therefore has to be disclosed? Nurse and midwife Brid Hehir looks at the example of the UK’s first FGM clinic for children and adolescents, which opened at University College London Hospital (UCLH) in 2014. A year after the opening of the unit, a report by UCLH announced that 38 girls had been referred to them, of which 18 were subsequently found to have had FGM. But of those 18, 11 had undergone Type 4, which is the term used by the World Health Organisation’s FGM classifications for a nick or small cut which leaves little or no scarring. Hehir argues that although Type 4 is far less severe that male circumcision, which is not illegal, health professionals refer the cutting ‘out of fear, not conviction.’ Not identifying a women with FGM carries a serious risk, which now extends to prosecution. Health professionals are very aware of the case of Dr Dhanuson Dharmasena, who was accused of re-infibulating a woman after her delivery at the Whittington Hospital in North London in 2012. In this case the umbilical cord was wrapped around the baby’s neck and his heartbeat was falling rapidly. Dharmesena carried out an emergency instrumental delivery during which he made an incision through her FGM scar tissue, and the baby was delivered alive. After delivery the tissue was bleeding and Dharmasena made one figure 8 stitch to halt blood loss, before being called away to an emergency C-section. This stitch was described in court as a reinfibulation. When the case eventually came to court the jury delivered a not-guilty verdict in less than half an hour. But while the case was being investigated by order of the General Medical Council, Dharmesana was not able to complete his training or work as a doctor for two years. An extraordinary consideration in this case was that it went to court against the express wishes of the mother herself, who did not support the prosecution and refused to provide the police with a statement.
Hehir also reports that she is increasingly aware of teenagers who have had FGM refusing to see their GP until they turn 18, even for health problems unrelated to FGM. They are afraid of the consequences for themselves and their families if their FGM is detected, and do not want to be responsible for the reporting of the family to social services and police.
With the introduction of the new laws, health, education and criminal investigation have been conflated. But are these severe interventionist measures really necessary, or do they introduce a nugatory benefit to the detriment of both health and educational professionals, and FGM-affected communities?
Sarah Penny is a South African-born novelist currently living in London where she is a lecturer in English and Creative Writing at Brunel University.