Female genital mutilation in the UK: considerations for best nursing practice

Female genital mutilation (FGM) is any process that injures or removes part or all of the external female genital organs for non-medical reasons. FGM is a growing public health concern in the UK because of an increase in migration from countries where it is widely practised. Education on FGM for nurses is key to supporting women who have undergone the practice, as well as safeguarding girls and women who are at risk. Nurses must understand the history and culture of FGM as well as the long-term health complications to be able to support affected women both professionally and sensitively.

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The prevention of female genital mutilation in England: what can be done?

Journal of Public Health ◽

10.1093/pubmed/fdy128 ◽

2018 ◽

Vol 41 (3) ◽

pp. e261-e266 ◽

Cited By ~ 5

Author(s):

E Plugge ◽

S Adam ◽

L El Hindi ◽

J Gitau ◽

N Shodunke ◽

...

Keyword(s):

Public Health ◽

Female Genital Mutilation ◽

Public Health Issue ◽

Global Public Health ◽

Criminal Offence ◽

Genital Mutilation ◽

Awareness Raising ◽

The Uk ◽

The Impact ◽

Female Genital

Abstract Background Female genital mutilation (FGM) is a global public health issue. Women in the UK are at risk of FGM and its adverse health consequences but little is known about its practice. Since 1985 it has been a criminal offence to perform FGM in the UK and further legislation has tightened the law but FGM continues. Methods Four community researchers from the Kenyan, Nigerian, Somalian and Sudanese communities in Oxford conducted focus groups and interviews with 53 people to understand the communities’ beliefs about how best to prevent FGM. Results Participants believed that the current UK legislation alone was not sufficient to tackle FGM and might in fact be counterproductive by alienating communities through its perceived imposition. They felt that there had been insufficient consultation with affected communities, awareness raising and education about the legislation. Community-led solutions were the most effective way to tackle FGM. Conclusions FGM adversely affects communities globally. In the UK, researchers from affected communities gathered data demonstrating the feasibility and importance of involving communities in FGM prevention work. Further research is needed to understand how best to prevent FGM in affected communities and, very importantly, to examine the impact of the UK legislation relating to FGM.

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Exploring the views of female genital mutilation survivors, their male partners and healthcare professionals on the timing of deinfibulation surgery and NHS FGM care provision (the FGM Sister Study): protocol for a qualitative study

BMJ Open ◽

10.1136/bmjopen-2019-034140 ◽

2019 ◽

Vol 9 (10) ◽

pp. e034140

Author(s):

Laura Jones ◽

Emma Danks ◽

Joanne Clarke ◽

Lailah Alidu ◽

Benjamin Costello ◽

...

Keyword(s):

Qualitative Study ◽

Female Genital Mutilation ◽

Best Practice ◽

Healthcare Professionals ◽

Health Concern ◽

Care Provision ◽

Male Partners ◽

Genital Mutilation ◽

The Uk ◽

Female Genital

IntroductionFemale genital mutilation (FGM) is a significant global health concern and is likely to become an increasingly important healthcare challenge in destination countries such as the UK owing to rising levels of migration from FGM-affected countries. Currently, there is no consensus on the optimal timing of deinfibulation (opening) surgery for women who have experienced type 3 FGM and care provision remains suboptimal in the UK. This qualitative study aims to explore the views of survivors, male partners and healthcare professionals (HCPs) on the timing of deinfibulation and delivery of NHS FGM services.Methods and analysisA qualitative study, informed by the Sound of Silence conceptual framework, will be undertaken via two work packages (WPs). WP1 will explore views on timing preferences for deinfibulation and NHS FGM services through interviews and discussion groups with FGM survivors (n~50), male partners (n~10) and HCPs (n~50). WP2 will use established techniques via two workshops (community (n~20–25 participants) and national stakeholder (n~30–35 participants)) to synthesise qualitative research findings and inform best practice and policy recommendations around the timing of deinfibulation and NHS FGM care provision. Supported by trained interpreters, data collection will be audio recorded and transcribed. Data will be analysed using the framework method to facilitate a systematic mapping and exploration of qualitative data from multiple sources.Ethics and disseminationThe study has received ethical approval from the North West Greater Manchester East Research Ethics Committee (18/NW/0498). The outputs for this study will be recommendations for best practice and policy around FGM care provision that reflects the views and preferences of key stakeholders. The findings will be disseminated via conference presentations, peer-reviewed publications, patient groups, third sector organisations and social media.Trial registration numberISRCTN14710507.

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“When my mother called to say that the time of cutting had arrived, I escaped to Belgium with my daughter”: Identifying turning points in the change of attitudes towards the practice of Female Genital Mutilation among migrant women in Belgium

10.21203/rs.2.20619/v1 ◽

2020 ◽

Author(s):

Afi A. Agboli ◽

Fabienne Richard ◽

Isabelle Aujoulat

Keyword(s):

Public Health ◽

Female Genital Mutilation ◽

Turning Points ◽

Health Concern ◽

Negative Consequences ◽

Gender Based Violence ◽

Deep Roots ◽

Genital Mutilation ◽

Patriarchal System ◽

Female Genital

Abstract Background Female Genital Mutilation (FGM) remains a public health concern with negative consequences on women’s health. It is a harmful practice and recognized in international discourses on public health as a form of gender-based violence of which women are not only victims, but also perpetrators. Although the practice of FGM remains a social norm which is difficult to change because of its deep roots in tradition and how it is embedded in the patriarchal system, some women have changed their attitudes towards it and speak out against it. This study identifies and describes turning points (TP) defined as significant events in the lives of the women, that create changes towards the practice of FGM.Methods We conducted an inductive qualitative study based on the life story approach where we interviewed 15 women with FGM. During the interviews the turning points that gave them the courage to change were identified together with the research participants. The analysis drew on lifeline reconstructions and thematic analysis.Results Six common turning points relating to a change in attitude towards FGM were identified: TPs related to encounters with health professionals, education, social interactions with other cultures and their own culture, experiences of motherhood, repeated pain during sexual or reproductive activity and to the fact witnessing some harmful consequences of FGM towards loved ones.Conclusion The turning points identified challenged the understanding of what it means to be a ‘member’ of the community in a patriarchal system, a ‘normal woman’ according to the community and what it means to be a good mother. In addition, the TPs found were expressed together with some issues related to emotional responses and coming to terms with conflict of loyalty, which we see as possible mechanisms to explain the change experienced by the women in our sample.

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“When my mother called to say that the time of cutting had arrived, I escaped to Belgium with my daughter”: Identifying turning points in the change of attitudes towards the practice of Female Genital Mutilation among migrant women in Belgium

10.21203/rs.2.20619/v2 ◽

2020 ◽

Author(s):

Afi A. Agboli ◽

Fabienne Richard ◽

Isabelle Aujoulat

Keyword(s):

Public Health ◽

Female Genital Mutilation ◽

Turning Points ◽

Health Concern ◽

Negative Consequences ◽

Gender Based Violence ◽

Deep Roots ◽

Genital Mutilation ◽

Patriarchal System ◽

Female Genital

Abstract Background: Female Genital Mutilation remains a public health concern with negative consequences on women’s health. It is a harmful practice and recognized in international discourses on public health as a form of gender-based violence of which women are not only victims but also perpetrators. The practice of FGM remains a social norm which is difficult to change because of its deep roots in tradition and how it is embedded in the patriarchal system. However, some women succeeded in changing their attitudes towards it and speak out against it. This study identifies and describes turning points defined as significant and critical events in the lives of the women, that create changes towards the practice of FGM. Methods: We conducted an inductive qualitative study based on the life story approach, where we interviewed 15 women with FGM. During the interviews, the turning points that gave them the courage to change were identified together with the research participants. The analysis drew on lifeline reconstructions and thematic analysis. Results: Six common turning points relating to a change in attitude towards FGM were identified: turning points related to (i) encounters with health professionals, (ii) education, (iii) social interactions with other cultures and their own culture, (iv) experiences of motherhood, (v) repeated pain during sexual or reproductive activity, and (vi) witnessing some harmful consequences of FGM towards loved ones. Conclusion: The turning points identified challenged the understanding of what it means to be a ‘member’ of the community in a patriarchal system, a ‘normal woman’ according to the community and what it means to be a ‘good mother’. Besides, the turning points found were expressed together with some issues related to emotional responses and coming to terms with conflicts of loyalty, which we see as possible common mechanisms to explain the change experienced by the women in our sample.

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Improving care for women and girls who have undergone female genital mutilation/cutting: qualitative systematic reviews

Health Services and Delivery Research ◽

10.3310/hsdr07310 ◽

2019 ◽

Vol 7 (31) ◽

pp. 1-216 ◽

Cited By ~ 6

Author(s):

Catrin Evans ◽

Ritah Tweheyo ◽

Julie McGarry ◽

Jeanette Eldridge ◽

Juliet Albert ◽

...

Keyword(s):

Health Care ◽

Service Delivery ◽

Pregnant Women ◽

Systematic Reviews ◽

Female Genital Mutilation ◽

Genital Mutilation ◽

Women And Girls ◽

The Uk ◽

Experienced Female ◽

Female Genital

Background In a context of high migration, there are growing numbers of women living in the UK who have experienced female genital mutilation/cutting. Evidence is needed to understand how best to meet their health-care needs and to shape culturally appropriate service delivery. Objectives To undertake two systematic reviews of qualitative evidence to illuminate the experiences, needs, barriers and facilitators around seeking and providing female genital mutilation-/cutting-related health care from the perspectives of (1) women and girls who have experienced female genital mutilation/cutting (review 1) and (2) health professionals (review 2). Review methods The reviews were undertaken separately using a thematic synthesis approach and then combined into an overarching synthesis. Sixteen electronic databases (including grey literature sources) were searched from inception to 31 December 2017 and supplemented by reference list searching. Papers from any Organisation for Economic Co-operation and Development country with any date and in any language were included (Organisation for Economic Co-operation and Development membership was considered a proxy for comparable high-income migrant destination countries). Standardised tools were used for quality appraisal and data extraction. Findings were coded and thematically analysed using NVivo 11 (QSR International, Warrington, UK) software. Confidence in the review findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation – Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. All review steps involved two or more reviewers and a team that included community-based and clinical experts. Results Seventy-eight papers (74 distinct studies) met the inclusion criteria for both reviews: 57 papers in review 1 (n = 18 from the UK), 30 papers in review 2 (n = 5 from the UK) and nine papers common to both. Review 1 comprised 17 descriptive themes synthesised into five analytical themes. Women’s health-care experiences related to female genital mutilation/cutting were shaped by silence and stigma, which hindered care-seeking and access to care, especially for non-pregnant women. Across all countries, women reported emotionally distressing and disempowering care experiences. There was limited awareness of specialist service provision. Good care depended on having a trusting relationship with a culturally sensitive and knowledgeable provider. Review 2 comprised 20 descriptive themes synthesised into six analytical themes. Providers from many settings reported feeling uncomfortable talking about female genital mutilation/cutting, lacking sufficient knowledge and struggling with language barriers. This led to missed opportunities for, and suboptimal management of, female genital mutilation-/cutting-related care. More positive experiences/practices were reported in contexts where there was input from specialists and where there were clear processes to address language barriers and to support timely identification, referral and follow-up. Limitations Most studies had an implicit focus on type III female genital mutilation/cutting and on maternity settings, but many studies combined groups or female genital mutilation/cutting types, making it hard to draw conclusions specific to different communities, conditions or contexts. There were no evaluations of service models, there was no research specifically on girls and there was limited evidence on psychological needs. Conclusions The evidence suggests that care and communication around female genital mutilation/cutting can pose significant challenges for women and health-care providers. Appropriate models of service delivery include language support, continuity models, clear care pathways (including for mental health and non-pregnant women), specialist provision and community engagement. Routinisation of female genital mutilation/cutting discussions within different health-care settings may be an important strategy to ensure timely entry into, and appropriate receipt of, female genital mutilation-/cutting-related care. Staff training is an ongoing need. Future work Future research should evaluate the most-effective models of training and of service delivery. Study registration This study is registered as PROSPERO CRD420150300012015 (review 1) and PROSPERO CRD420150300042015 (review 2). Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Ending female genital mutilation in the UK

The Lancet ◽

10.1016/s0140-6736(13)62353-3 ◽

2013 ◽

Vol 382 (9905) ◽

pp. 1610

Author(s):

The Lancet

Keyword(s):

Female Genital Mutilation ◽

Genital Mutilation ◽

The Uk ◽

Female Genital

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Prosecution of female genital mutilation in the United Kingdom: Injustice at the intersection of good public health intentions and the criminal law

Medical Law International ◽

10.1177/0968533220914070 ◽

2019 ◽

Vol 19 (4) ◽

pp. 258-281 ◽

Cited By ~ 1

Author(s):

Marge Berer

Keyword(s):

Public Health ◽

United Kingdom ◽

Criminal Law ◽

Female Genital Mutilation ◽

Public Health Issue ◽

Traditional Practice ◽

Genital Mutilation ◽

The United Kingdom ◽

Health Intentions ◽

Female Genital

Female genital mutilation (FGM) is a harmful traditional practice and a serious public health issue in the countries where it is carried out. It is also a violation of the rights of the girls to whom it is done. The main action taken in the United Kingdom to stop FGM, has been to criminalise it. Public health measures, such as the provision of specialist clinics for those who experience complications of FGM have been implemented as well, and some education in schools is provided. This article is about the injustice that has arisen from the pursuit of prosecutions for FGM in the United Kingdom, in spite of good public health intentions. Since 2012, there have been four criminal cases, several arrests that never came to trial, and for reasons of safeguarding, an unknown number of investigations with the threat of girls being taken into care, and people stopped from travelling with girl children to visit their families in FGM-practising countries. To date, only one criminal case in 2019 – R v. N (FGM) – which is the main subject of this article, has resulted in a guilty verdict. This article outlines this history in relation to the criminal law and uses courtroom observation to analyse what happened in the 2019 case in detail. It argues that the conviction depended on medical opinion and the highly uncertain evidence of two children and was influenced by a spurious link to witchcraft that should never have been permitted in the courtroom. It argues that this conviction is unsafe and should be appealed. It further argues that to use protection orders only because a child’s mother had FGM, in the absence of any evidence of risk, is discriminatory and a form of impermissible racial/ethnic profiling. The article concludes that the United Kingdom should stop recording a history of FGM in women seeking healthcare. It calls for the current law against FGM to be reconsidered and replaced with positive measures for countering FGM which have the support and involvement of the community groups to whom they are addressed.

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Failure to Protect Girls from Female Genital Mutilation

The Journal of Criminal Law ◽

10.1177/0022018315603593 ◽

2015 ◽

Vol 79 (5) ◽

pp. 344-357

Author(s):

Theodora A. Christou ◽

Sam Fowles

Keyword(s):

Female Genital Mutilation ◽

Criminal Liability ◽

Responsibility To Protect ◽

Parental Responsibility ◽

Genital Mutilation ◽

International Obligations ◽

The Law ◽

Failure To Protect ◽

The Uk ◽

Female Genital

Whilst FGM had been a crime in the UK for over 2 decades, over 60, 000 girls continued to be mutilated. In 2015 the UK took its international obligations to protect girls from such physical harm more seriously and enacted new legislation. This article focuses on the parental responsibility to protect their daughter from harm and their criminal liability if they fail to take adequate action to prevent the mutilation occurring. We explore the socio-legal setting, the gaps in the law, the state's international obligations and finally the newly introduced rebuttable presumption.

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