Catholic Medical Quarterly Volume 67(3) August 2017
Female Genital Mutilation: Awareness and Prevention
Monica Sharp RGN.
I am a Paediatric Nurse in a unique position to help have an impact towards ending Female Genital Mutilation (FGM) as well as raise awareness of the problem. I am the FGM Lead for West Mercia Crimestoppers, an independent charity that encourages people to report crime whilst guaranteeing anonymity. FGM is a procedure that involves partial or total removal of external female genitalia or causes injury to female genital organs for nonmedical reasons (WHO 2014  )
There are nearly 140,000 girls and women now living in the UK who are thought to have been affected by FGM , most of whom have had the illegal procedure performed abroad. Worldwide approximately 200 million girls and women are affected by FGM (UNICEF 2016)  and the procedure is still practiced in at least 28 countries in Africa, the Middle East and Asia. There are no authoritative figures showing the true extent of how many women and children have been affected. FGM can occur at any age from newborn, to young children, adolescents and women before marriage and during pregnancy. It is thought that girls are most at risk in the UK from undergoing FGM during school holidays when they are taken abroad by parents or family, often referred to as the “cutting season”. Girls at risk may have an extended summer break from school and may talk about coming back as a `woman’ or mention having to attend a special ceremony.
There are no known health benefits from FGM  – only a long list of devastating and traumatic complications. Initial symptoms may include haemorrhage, pain, shock, wound infection, vaginal fistulae, urine retention and even death. Long-term complications may include pain, chronic infection from obstruction to menstrual flow, recurrent urinary tract infections, renal complications, pelvic inflammatory disease, infertility and neuromata (benign tumours of nerve tissues caused by damage when nerve endings have been cut). Pregnancy brings further risk of complications. Prolonged labour, uterine inertia or rupture can bring life-threatening risks to both mother and infant. This is in addition to the lasting psychological impact with survivors often enduring Post Traumatic Stress Disorder leading to flashbacks, nightmares, fear and anxiety. FGM became a crime in 1985 but since 2003 anyone who takes a child out of the country to have her genitalia cut faces a maximum sentence of up to 14 years. It is still believed to be underreported with victims often too fearful of family or community reaction to come forward. Crimestoppers has launched “The True Face of FGM”  campaign across the West Mercia area urging people to speak out against the hidden harms of FGM and its serious physical and emotional harm on survivors. Crimestoppers have been working in partnership with healthcare professionals as well as FGM survivors themselves - some of whom are themselves healthcare professionals). Doctors, midwives and emergency ambulance crews are key frontline workers in detecting and helping to prevent FGM.
Crimestoppers believes that anyone can contribute to the fight against FGM by passing on information that might protect a young girl at risk. As an independent charity, Crimestoppers are in a unique position of not wanting or taking people’s personal details. By calling 0800 555 111 you can give information totally anonymously or visit Crimestoppers website and use the non-traceable online form to pass on information about crime www.crimestoppers-uk.org
Specialist clinics, counselling, maternity advice clinics and FGM support groups now exist nationally to help women deal with psychological trauma, surgical treatments and sexual health problems caused by FGM. Surgical reversal and/or de-infibulation treatments are helping women recover from some of the debilitating symptoms. Many survivors long for reconstructive surgery to restore their wholeness and bring hope. However, due to a lack of trained surgeons, there are only a handful who can perform this worldwide.
Sign posts for help www.forwarduk.org.uk
Daughters of Eve www.dofeve.org
FGM has been especially endemic in parts of Sub-Saharan Africa. It is there also that obstructed childbirth leads to the formation of vesico-vaginal fistulae. This causes permanent incontinence. As a result of that, women are cast out from society The late Mr John Kelly, an obstetrician and gynaecologist in Queen Elizabeth Hospital Birmingham spent many visits to Sudan repairing women with fistulae. As he once said “Compassion indicates one has total respect for the patient, on the same level, while pity may suggest the carer is on a higher level. Many of these women have experienced terrible ordeals in labour, either at home or sadly in hospital. Rehabilitation, an important aspect of treatment, should commence at the patient's first visit, where she is treated with respect. I was working with such poor women for 13 years before one of them taught me a lesson. When offered an appointment she replied, "They will not let me on the bus when I am leaking!" 
John visited Uganda, Ethiopia, Zambia, Darfur in the Sudan, Pakistan and Ghana on a regular basis. The hospitals involved were aware of his dates and the patients were assembled by radio and “Bush Telegraph”.
John died in 2013 . But his work reminds us that, as Catholics, we must engage with women who have or who may suffer from FGM or be harmed in childbirth. In doing so, we will, of course, not promote abortion or other unethical practices.
But we cannot and must not ignore the plight of those women and girls who are at risk of serious harm and mutilation from FGM or from poor care during childbirth. The Church has always championed the rights and dignity of the disadvantaged.
Long may that continue!
- World Health Organisation (2014) Female Genital Mutilation fact-sheet
- Macfarlane and Dorkenoo (2014) Female Genital Mutilation in England and Wales
- UNICEF (2016) Female Genital Mutilation /Cutting: A Global Concern https://www.unicef.org/media/files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf
- Royal College of Nursing Female Genital Mutilation – An RCN resource for Nursing and Midwifery Practice (Third edition 2016 review date 2016)
- Crimestoppers Trust “The True Face of FGM” Campaign – West Mercia Combats A Female Genital Mutilation (2017)
- Kelly J (2011) Obstetric Fistulae and the Developing World. Catholic medical Quarterly 61(2): http://www.cmq.org.uk/CMQ/2011/2-Obstetric-fistulae.html
- Mr John Kelly, FRCOG, OBE HONMD. Obituary Catholic Medical Quarterly Volume 63(4) November 2013 www.cmq.org.uk/CMQ/2013/Nov/John_Kelly_Oration.html/