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Midwives can play key role in preventing FGM, says expert

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A policy advisor at the Royal College of Midwives has told Nursing Times that midwives should receive “continuous education” to help them efficiently identify and prevent female genital mutilation (FGM).

Janet Fyle said the duties of a midwife to their patients should go beyond the clinical to include wider issues that may affect their pregnancy such as FGM and domestic abuse.

“It’s about identifying those women so they don’t turn up in labour needing defibulation”

Janet Fyle

Her call follows new figures from NHS Digital that show 1,675 people attended a hospital, mental health provider or GP practice for an issue relating to FGM between April and June 2018.

The data shows 680 of those attendances were to a midwifery service.

While FGM is mostly carried out in Africa and the Middle East, the figures show 25 people who went for a health care appointment in that period had undergone the procedure in the UK.

Of those 1,675 individuals, 1,015 were identifying for the first time as having FGM – the lowest quarterly level since those records began in April 2015.

“We are urging that it is not only the clinical aspects of the women we are looking at”

Janet Fyle

While midwives do not receive specific training in FGM, Ms Fyle said the RCM was encouraging NHS midwifery directors to make sure their staff knew the red flags and how to support either victims or those at risk. 

Ms Fyle said the questions routinely asked by midwives, such as the patient’s country of origin, how many children they have, and if they had any problems with previous births, could help to raise alarm bells.  

She added that the college was working to circulate to midwives a “map of prevalence”, which shows the countries in which FGM is most commonly practised such as Somalia, Sudan, Egypt and Mali.

Ms Fyle said: “We are doing a little bit better now in terms of the health service offering women the defibulation [reconstructive surgery after FGM] and other types of health care.

“But it’s about identifying those women so they don’t turn up in labour needing defibulation and always thinking in parallel about safeguarding any girl children that the women may have,” she told Nursing Times.

“We are trying our best at the RCM to impress upon heads of midwifery at NHS trusts to ensure midwives are aware,” she said.

“Sometimes I don’t like to use the word training, it’s more awareness”

Janet Fyle

She added: “Sometimes I don’t like to use the word training, it’s more awareness and this continuous education around key public health issues like violence against women and domestic abuse, FGM, safeguarding, etc.

“We are urging that it is not only the clinical aspects of the women we are looking at,” she said. “It’s also the public health aspects, the things that are not purely midwifery, because there are other things going on in their lives that may impact their pregnancy and labour.”

Ms Fyle noted that FGM had long-term physical and psychological impacts and referenced one study that showed the levels of post-traumatic stress disorder among FGM victims to be similar to those seen in soldiers who had gone to war.

Royal College of Midwives

Janet Fyle

Janet Fyle

She already has a strong track record on the issue. In 2016, Ms Fyle was awarded an MBE for her services to tackling FGM.

Her work has included co-authoring a 2014 intercollegiate report that set out a number of recommendations for identifying recording and reporting FGM, including empowering frontline health professionals with the competence, knowledge and awareness to deal with FGM.

The same year the Department of Health launched an FGM prevention programme and made it compulsory for health staff to document in a patient’s medical record if they are identified as having undergone the procedure.

In October 2015, it became mandatory for care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police.

FGM has been a crime in the UK since 1985 but to date there have been no convictions.

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