Today marks the UN International Day of Zero Tolerance for Female Genital Mutilation (FGM) with renewed calls for global action to end FGM.
A range of health and legal initiatives to tackle FGM have been introduced in the UK. This includes the requirement for health professionals to submit confidential patient data to the FGM Enhanced Dataset, and the Serious Crime Act 2015 to mandate professionals in health, social care, and education to report to the police all girls under 18 who disclose or have physical evidence of FGM with a view to criminal investigation. Successful prosecution is seen as an effective deterrent to FGM, sending unequivocal messages to cutters and parents that the law is taken seriously.
In the public discourse around FGM that will occur today, we must also be mindful that women affected by FGM must be supported to understand their own anatomy and how to spot worrying signs and symptoms, as well as to access preventative cancer screening and wider reproductive healthcare. We do not want to see women and girls with FGM deterred from seeking help for complications, or even engaging with health professionals on unrelated matters, for fear that their FGM will be “outed” and police will get involved. We can ill-afford for loss of trust and perceived threat of prosecution to further embed existing disparities in health access and outcomes in black and ethnic minority women. We must also fill the gaps which exist in health information and services that would support clinicians to have the right conversations around screening and reproductive health, and women to access these services.
It is a shameful fact that even today, a black woman is over four times more likely to die in pregnancy than a white woman. Disproportionately more black and Asian women continue to die from breast, cervical and uterine cancer in the UK. Delayed presentation with symptoms may contribute to the poorer survival and we know that uptake of breast and cervical cancer screening as well as HPV vaccination is much lower in BAME communities. Research from the UK and elsewhere suggests fear, shame and embarrassment as important barriers for women from these communities attending cervical screening. Fear of being judged, or viewed as abnormal alongside negative past experiences of examination are reported by women with FGM as additional barriers to cervical screening.
We must have a focus on the services, support and information that women who are living with the consequences of FGM need around their gynaecological health. We must equip GPs, nurses and specialists with the information and insights to provide the best care and solutions to enable these women to look after their own health, understand their bodies and signs and symptoms that require further checks. We must encourage and support them to attend screening.
The answers for how we do this are there – in the communities and with clinicians and charities who are supporting women affected by FGM. We need to listen to what they need and respond by producing the right services, materials and messages delivered in a way that reaches them and helps them to take action.
The criminal justice messaging around FGM is important, but as a specialist clinician working with women affected by FGM, the health messaging and support to equip women to look after their health needs to be much stronger.
Brenda Kelly is a consultant obstetrician at Oxford University Hospitals NHS Foundation Trust. She is also clinical lead of the Oxford Rose Clinic, a specialist service for women and girls with FGM, and patron of the charity Oxford Against Cutting. Brenda works alongside community practioners and consulted with Filsan Ali, director of the Midaye Somali Development Network when writing this blog. This networkdelivers FGM community awareness and engagement activities in Kensington and Chelsea, Hammersmith and Fulham, Westminster, Brent, Wandsworth, and Birmingham. It also provides a community health advocacy service at the FGM clinics for Imperial College Healthcare NHS Trust, and Chelsea and Westminster Hospital NHS Foundation Trust.
Clinics in UK:
The Eve Appeal runs a nurse information service, Ask Eve, which is staffed by a specialist gynae nurse specialist. For free, confidential, expert information contact: firstname.lastname@example.org