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Detecting and preventing female genital mutilation

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VOL: 103, ISSUE: 31, PAGE NO: 23

The Metropolitan Police Service (2007a) has launched a child protection campaign to prevent female genital mutilati…


The Metropolitan Police Service (2007a) has launched a child protection campaign to prevent female genital mutilation (FGM). It has taken the unusual step of offering a maximum £20,000 reward for information leading to the arrest and prosecution of anyone carrying out FGM in London. The service is urging nurses and other healthcare professionals to be vigilant for any signs of FGM. The campaign, launched by the service’s child abuse investigation command this month, is called Project Azure.



In the UK, it is estimated that as many as 6,500 girls are at risk of FGM a year (Foundation for Women’s Health, Research and Development - FORWARD, 2007). The summer holiday is believed to be the most common time for FGM to be carried out because it allows time for girls to recover from the physical effects (MPS, 2007a).





FGM is administered in the UK and abroad ‘for what is considered in many cases to be cultural reasons… [and] sometimes for chastity or misguided religious beliefs’ (MPS, 2007a). However, the MPS stresses that its campaign is not an attack on culture or faith; it is intended to raise awareness that this is ‘extreme child abuse’, is illegal and will not be tolerated.



The MPS states that FGM is a violation of human rights and a criminal offence, and to administer or arrange for it to be carried out could lead to imprisonment of up to 14 years. The police service recently reported that a woman was arrested in London on suspicion of arranging FGM, following its awareness campaign (MPS, 2007b).



Under the Female Genital Mutilation Act 2003, a person is guilty of an offence if they excise, infibulate or otherwise mutilate the whole or any part of a girl’s labia majora, labia minora or clitoris. Exceptions are for surgical operations performed on specific physical or mental health grounds, and operations performed for purposes connected to labour or giving birth, by registered medical practitioners or registered midwives. Other offences covered by the act are assisting a girl to mutilate her own genitalia and assisting a non-UK person to mutilate overseas a girl’s genitalia. For full information on the act, see





The World Health Organization (2000) estimates that 100-140 million girls and women have undergone FGM worldwide, and that each year a further two million girls are at risk. UNICEF (2007) estimates that, given current birth rates, some three million girls are at risk of genital mutilation a year.



According to the WHO, most of the women affected live in 28 African countries and some live in Asia and the Middle East. They are also increasingly found in Europe, Australia, New Zealand, Canada and the US, primarily among immigrants from countries where FGM is the tradition.



In the UK, Waltham Forest Local Safeguarding Children Board (LSCB) has developed a local strategy and prepared information on FGM, following the launch of Project Azure, to raise awareness among professionals working with children. It states that there are substantial populations from countries where FGM is endemic in London, Liverpool, Birmingham, Sheffield and Cardiff, but it is likely that communities in which FGM is practised reside throughout the UK (Waltham Forest LSCB, 2007).





According to the WHO (2000), FGM (often referred to as ‘female circumcision’) comprises ‘all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons’. There are different types of FGM (see Box, right).



The most common type of mutilation is excision of the clitoris and the labia minora, accounting for up to 80% of all cases. The most extreme form is infibulation, which constitutes about 15% of all procedures.



Health consequences of FGM



The immediate and long-term health consequences of FGM vary according to the type and severity of the procedure performed. The WHO (2000) states that the immediate complications include:



- Severe pain;



- Shock;



- Haemorrhage;



- Urine retention;



- Ulceration of the genital region and injury to adjacent tissue;



- Haemorrhage and infection causing death.



The WHO reports that concern has arisen about possible transmission of HIV due to the use of one instrument in multiple operations, but this has not been the subject of detailed research.



Long-term consequences include:



- Cysts and abscesses;



- Keloid scar formation;



- Damage to the urethra resulting in urinary incontinence;



- Dyspareunia;



- Sexual dysfunction;



- Difficulties with childbirth.



The WHO explains that there are also implications for psychosexual and psychological health. Genital mutilation may leave a ‘lasting mark’ on the life and mind of the woman who has undergone it and, in the longer term, women may suffer feelings of incompleteness, anxiety and depression.





In cultures where it is an accepted norm, FGM is practised by followers of all religious beliefs as well as animists and non-believers (WHO, 2000). It is usually performed by an older woman with no medical training, using crude instruments and without anaesthetic. Among the more affluent, it may be performed in a healthcare facility by qualified health personnel, but the WHO points out it is opposed to the medicalisation of all types of FGM.



UNICEF states that FGM and cutting of genitalia is mainly performed on children and adolescents between four and 14 years of age. However, in some countries such as Ethiopia, more than half of FGM is performed on infants under one year old (UNICEF, 2007). The WHO explains that the age at which FGM is performed varies from area to area, ranging from infants a few days old to occasionally mature women.



The Metropolitan Police reports that often parents or grandparents of the child facilitate the procedure, which is often done on the pretence that the child will be receiving a special gift, going on a vacation or ‘becoming a woman’ (MPS, 2007a). The children are often restrained by adults who hold them down as they endure the extremely painful procedure.



The reasons given by families for having FGM performed include (WHO, 2000):



- Psychosexual reasons: reduction or elimination of the sensitive tissue of the outer genitalia, particularly the clitoris, in order to attenuate sexual desire in the female, maintain chastity and virginity before marriage and fidelity during marriage, and increase male sexual pleasure;



- Sociological reasons: identification with the cultural heritage, initiation of girls into womanhood, social integration and the maintenance of social cohesion;



- Hygiene and aesthetic reasons: the external female genitalia are considered ‘dirty’ and ‘unsightly’;



- Myths: enhancement of fertility and promotion of child survival;



- Religious reasons: some Muslim communities practise FGM in the belief that it is demanded by the Islamic faith. The practice, however, predates Islam.



The different types of FGM


- Type I - excision of the prepuce, with or without excision of part or all of the clitoris;



- Type II - excision of the clitoris with partial or total excision of the labia minora;



- Type III - excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation);



- Type IV - pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterisation by burning of the clitoris and surrounding tissue;



- Scraping of tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts);



- Introduction of corrosive substances or herbs into the vagina to cause bleeding or to tighten or narrow it; and any other procedure that falls under the definition given by the WHO (see above).



Source: WHO (2000)

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