This site is intended for Healthcare Professionals only

Female genital mutilation: the cruellest cut

Analysis bookmark icon off

Female genital mutilation: the cruellest cut

Female genital mutilation is a violation of human rights and a form of child abuse, which all healthcare professionals have a responsibility to help stop. We investigate the issue

LEARNING OBJECTIVES: After reading this article you should:

  • Understand the growing concern about the problem of female genital mutilation.
  • Read the RPS guidance on protecting children and young people.

 The World Health Organization (WHO) defines female genital mutilation (FGM) as “all procedures that involve the partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons”.

It is often referred to as female circumcision but charities against gender-based violence reject this term because it suggests that the practice is equivalent to male circumcision. It is not.

Where is it practised?

FGM is practised in 29 African countries, including Ethiopia, Eritrea and Sudan. Prevalence ranges from under 10 per cent in Uganda and Cameroon to over 90 per cent in Egypt and Somalia. The WHO estimates that more than 125 million African females have undergone the procedure, while three million more are at risk. But the problem is not confined to Africa.

FGM also takes place in parts of Yemen, Oman and Iraqi Kurdistan, in some Bedouin communities in Israel, and among certain Muslim groups in India, Pakistan, Malaysia and Indonesia. As a result of immigration and refugee movements, FGM is becoming increasingly common in the West.

A recent NSPCC survey found that over 1,700 FGM victims had been referred to specialist clinics in England over the past two years. According to NSPCC head of child protection operations, John Cameron: “Over 20,000 girls in the UK are at risk of getting cut each year.”

Four categories

There are four categories of FGM:

• Type I (clitoridectomy) refers to the removal of the hood (prepuce) of the clitoris

• Type II (excision) describes the removal of the prepuce and clitoris with partial or total excision of the labia minora

• Type III is the most extreme form, with the external genitalia removed entirely and the vulva stitched closed to the width of the head of a matchstick (infibulation)

• Type IV includes all other forms of mutilation to the female genitalia, including pricking, piercing, incising, scraping and cauterisation.

The age of mutilation ranges from a few days old to adolescence but it is occasionally performed on pregnant women and widows. 

“Practitioners often have little or no medical training, working in poor hygienic conditions, with little concept of vascular or neurological pathways or reconstructive surgery,” says Dilip Chauhan, a Hackney-based community pharmacist with strong views on the issue.

Rite of passage

There are numerous reasons behind FGM. It is often seen as a rite of passage into womanhood or a condition of marriage. Some communities believe that the practice is a religious requirement when, in fact, FGM is not advocated by any religion and predates Islam by several centuries. In some cultures, it is regarded as a means of preserving a girl’s chastity, honour or cleanliness; it is even believed to enhance fertility and increase male sexual pleasure.

Families are put under tremendous pressure to force FGM on their daughters. Failure to comply may result in rejection in marriage and public shaming. Conversely, girls who undergo FGM are rewarded with gifts, respect and the ability to participate in adult social functions.

Whatever justifications are given, FGM is nothing more than “a form of patriarchal behaviour that stems from male oppression of women”, says Cameron, while Chauhan describes it as “a misogynistic practice to perpetuate the myth of ‘purity’, irrespective of which sex carries it out”.

FGM brings only harm. In the short-term, it can cause severe pain, shock, tetanus or sepsis,  urine retention, haemorrhage and even death. Long-term complications include recurrent bladder and urinary tract infections, cysts, infertility, pregnancy and childbirth complications, urination and menstruation problems, and severe psychological damage.

“Being held down and cut with a razor blade with no anaesthetic causes severe psychological trauma and has a huge impact on a woman’s future relationships and perceptions of herself as a woman and an individual, and then she will come under pressure to have it done to her own daughters so the suffering continues,” says Cameron.

It is often seen as a rite of passage into womanhood or a condition of marriage

Growing opposition

Thankfully, there is a growing movement against FGM worldwide. The UN recognises FGM as a violation of human rights, an act of gender-based violence and a form of child abuse. In the UK, it has been illegal to perform FGM since 1985 and to send a child abroad for it since 2003, carrying a 14- year prison sentence. Yet no-one has ever been prosecuted.

Professional dilemma

Cameron believes that professionals may be reluctant to report FGM due to cultural sensitivities or fears that a child who is otherwise well cared for will be removed from her family.

Furthermore, healthcare professionals may face the dilemma of undermining patient relationships and breaching confidentiality. “The law alone won’t help unless we work with communities to change attitudes and behaviours and unless people understand what FGM is about and the harms it causes,” he says.

Progress is being made, however. Last month, education secretary Michael Gove agreed to encourage all headteachers in England to discuss FGM in schools, following a petition. And the Royal College of General Practitioners, together with the Royal Colleges of Midwives and Obstetricians and Gynaecologists, released a report with recommendations on protecting girls, providing early support to new mothers and recording cases. In 2013, the NSPCC launched a free 24-hour helpline (0800 028 3550) and email (fgmhelp@nspcc. org.uk) for anyone concerned about FGM.

As frontline healthcare professionals, pharmacists have a responsibility to safeguard children from abuse. RPS spokesperson Neal Patel advises concerned pharmacists to consult the RPS guidance on protecting children and young people. According to Cameron, pharmacists should be aware that girls from practising communities are most at risk around the age of eight years and during the summer and Easter holidays. He urges them to report their suspicions by calling the police, social services or the NSPCC helpline.

“The key to reducing this activity is being able to identify families and groups where it occurs,” he says. “This is a most abhorrent, horrific and totally unacceptable form of child abuse and we cannot allow it to continue.”

Key facts

  • Over 20,000 girls in the UK are at risk of FGM each year.
  • Consequences include severe pain, urination and menstruation problems, and psychological damage.
  • FGM has been illegal in the UK since 1985 but no-one has ever been prosecuted.
Copy Link copy link button

Analysis

It’s time to delve deeper into health discussions. Broaden your understanding of a range of pharmacy news and topics through in-depth analysis and insight.

Share: