FGM in Barking and Dagenham

By a Resident of Dagenham

March 2017

Many of you will have seen the February episode of Call the Midwife where the Midwives of Nonnatus house deliver the baby of a woman from Somaliland who has undergone female genital mutilation (FGM), once called female circumcision, also called cutting. On initial examination Mrs Farah is found to have ‘no more below than that child’s plastic doll’. The baby is born safely through an emergency episiotomy but the midwives are unable to prevent Mrs Farah’s younger sister being returned to Somaliland on the orders of her grandmother to be mutilated during the school holidays. Mrs Farah gives the midwives a passionate defence of her culture and the honour in which her sister will be held; but the voice over by Vanessa Redgrave tells us that after living in England for some years she does not send her own baby daughter for the procedure.

There are various forms or degrees of FGM. To be brief the clitoris or part may be removed (clitorectomy) and all or part of the labia minor and major may be removed. At its most drastic form all of this will be completed by abrasion of the inside of the vagina the sides of which are then stitched together sealing the vaginal passage. The edges of the labia will be sewn together (infibulation) and a small hole left for the exit of urine and menstrual fluid. The process is extremely painful and leaves girls prone to bladder and urine infections, and other infections of the urogenital system. The mere act of visiting the lavatory can take a woman half an hour – drip- drip –drip… The long term effect on women’s health is far beyond the initial agony, if they survive the process. Girls die of shock, infection and blood loss. It is usually performed well before the girl reaches puberty; depending on the region from 4 days old (Yemen) into the mid-teens (Kenya). In most cases the girl is too young to understand what is to happen, to have any say in it, a chance to protest or avoid the ordeal.

So why is it done? It is a practice in more than one culture and the reasons vary. There is a strong element of making sure that a girl remains a virgin until marriage and a chaste wife thereafter. Some Middle Eastern urban societies can enclose their women in harems where they work indoors or in buildings lit by an internal courtyard.  But in rural societies, especially nomadic ones in North and North East Africa women are expected to work in the fields and with livestock. Instead of sealing them within a family workshop it was found convenient to seal them internally and they can be safely sent into the meadows to herd the goats.

Some elders believe that the very pain is itself a good thing because it makes the girls into obedient, submissive, enduring women who will bear all troubles inflicted on them stoically and silently.

The practice is more prevalent in Islamic cultures of Somalia, Egypt, North Africa and some parts of the Middle East. I have met Pakistani Muslims who are horrified at the idea.

Some Muslims will say it is not part of Islam; others that it is and they are reluctant to see that the damage it causes is any sort of problem.

A Muslim might say “There is nothing in the Koran mandating this” Which is true; the Koran only mandates male circumcision. The holy writ upon which proponents of FGM rely is one of the Ahadith, the sayings and deeds of Mohammed collected by his friends and family. Mohammed is the perfect man, to be emulated in all things, so if he did something or approved of something, all Muslims must follow.  The Hadith concerned is in the collection compiled by Iman Abu Dawud, and was recollected by Umm Atiyyah al-Ansariyyah who was one of Mohammed’s female companions. She narrated “A woman used to perform circumcision in Medina. The Prophet (peace be upon him) said to her: Do not cut severely as that is better for a woman and more desirable for a husband.”
In other words it is a good thing, but do not take to extremes.

I once had a discussion with a prominent Saudi born cleric on the subject. “Genital mutilation is wrong” he said. “But circumcision, done properly is a blessing and an honour for a woman” This was in east London; a conversation with a man of influence in London and England currently.

People will say, “But the practice predates Islam”. It does. I will quote the Somali born writer Ayaan Hirsi Ali here. She underwent FGM in her own childhood. She wrote “Muslim scholars have never condemned the ritual of female circumcision because in Islam the importance of virginity at marriage counts so heavily. When they came into contact with this tribal ritual they must have thought, Hey, wouldn’t that be a good way to guarantee a girl’s virginity? Excellent!”¹

People will say “But other cultures practice it” and they do; but for different reasons and they are amenable to change. For example, the Dassanech tribe of East Africa, of animist belief, told BBC documentary maker Bruce Parry, as part of the series Tribe, that during labour the clitoris will expand and suffocate the emerging baby, kill the mother and damage the rest of the family. So the clitoris is removed from the woman before she marries and starts a family. As Christianity spreads in East Africa, combined with modern education about the behaviour of the clitoris, helped by the efforts of the Mother’s Union, women have begun to drop the practice. In some Muslim dominated countries where the few Christians are heavily persecuted the Christians may perform FGM on their daughters in the hope that conformity to the Islamic norm will reduce the amount of persecution their daughters will suffer. The female genitals are seen as dirty. Removal will render a girl clean and pure.

In that episode of Call the Midwife Nurse Crane says that “this” (FGM) was performed in the UK in years gone by. As FGM it wasn’t. But during the 19^th century a few doctors working with women with mental health problems did perform clitorectomies. The thinking was that removing an organ of excitement and stimulation might sooth and calm women whose symptoms were severe agitation and paranoia. It wasn’t effective, the theory was erroneous, and like phrenology as a doctrine it is no longer performed other than to treat some very rare cases of cancer.

When I was asked to write this essay I thought some local facts would be useful so I made a freedom of Information request to the London Borough of Barking and Dagenham and the Barking, Havering and Redbridge University Hospitals NHS Trust.

I asked the Council for the figures for the last three years of girls and women who have been found to have undergone the procedure, broken down into age groups. Whether this was discovered by the school or social services, and “How many times have steps been taken, and what were those steps, to prevent a young girl undergoing the procedure?  In how many cases was the girl removed into council care? In how many cases were the police involved? “

They replied (Appendix i) that for the year 2015/16 90 instances of FGM were dealt with. 43 were aged 0-4, 34 of primary school age, 6 referred through education, the majority through health care professionals. For the year 2016/17 78 cases were dealt with; 42 girls aged 0-4, 24 primary school age and the majority again referred through health care. To my other questions they replied that they could not answer as either they did not keep data or the question was best addressed to the Area Health Authority.  I am not sure why Barking and Dagenham Council does not keep statistics of the activities of their own social workers, or why they think those activities are supervised by Queens and King George’s hospitals.

I asked Barking, Havering and Redbridge University Hospitals NHS Trust for information about the number of women presenting at maternity departments having undergone FGM. They replied:

2015-16 at booking: 114 2015-16 at delivery: 78

2016-17 at booking: 103 2016-17 at delivery: 96

I did not expect them to be able to break down their figures to a specific borough. I was given a link to the NHS digital dataset which has some very general national statistics but no answers to specific questions about our specific area.

I asked whether there is a specialised team of midwives or unit comparable to that of Queen Charlotte hospital. They answered that there is a consultant obstetrician with a special interest in FGM, otherwise I was referred to a Government General Information leaflet with no specific information to answer my request.

I also asked for figures of deaths of mothers or babies due to complications caused by FGM, and the number of women presenting at the urogenital clinic with problems, as well as details of repair facilities. The final part of my request was for details of women or girls attending A&E as an acute emergency from a recently performed procedure and how many of these resulted in a report to the police.

I got the same answer repeated to all questions, “We cannot answer this request as it is not possible to code a procedure which is likely to have a direct connection to FGM as asked. The fact that a woman has undergone an FGM procedure at some point in her life does not necessarily bear relevance to the condition for which we have treated them or for which they had been admitted”

And repeated several times at intervals “The FGM mandatory reporting duty is a legal requirement provided for in the FGM Act (2003) as amended by the Serious Crime Act (2015). The Trust follows these guidelines.”

What they seem to be saying is that they comply with the guidelines to inform the police, but can’t say how many times they have done it.

Meanwhile one of UKIP’s policies is to introduce screening for FGM among those girls feared to be at risk. This is quite sensible. Schools already screen reception children for height, weight, hearing etc. and woe betide any parent whose child carries a little puppy fat. Surely the threat to health and future well-being that FGM poses to a girl is far more drastic. FGM is a form of child abuse. Teachers and all people working with children are constantly exhorted to be vigilant for child sex abuse. This is a form of abuse and of the sexual organs.

When Ayaan Hirsi Ali was the equivalent of a City Councillor in Amsterdam in the 1990s she put forward proposals for a screening programme². A copy is attached as Appendix ii.

As she says, this must not be tolerated. It has been a crime in the UK since 1985, and a crime to remove a child to another country for that purpose since 2003. The penalty is up to 14 years in prison. There has been only one prosecution in all that time, a doctor who was acquitted as he was found to be repairing his patient after FGM not performing it. If 90 girls under the age of majority in one year, in one borough, are found to have suffered the process, or be at risk of it, how many cases nationally in the years since 2003?

And not a single substantive prosecution.

It is a scandal and a shame upon a civilised country.

--

1 The Caged Virgin P105

2 Chap 12 Genital Mutilation Must not be Tolerated P126

Appendix i – Figures from LBBD [see attached below]

Appendix ii Copy of Proposals for a screening programme from The Caged Virgin. [see attached below]