Female genital mutilation (FGM) is a deeply sensitive issue and is part of the spectrum of abuse that is faced by women globally. It is emerging as an urgent public health and social care issue in the UK due to the grave and lifelong consequences of the practice. In 2007 it was estimated that 66,000 women in the UK had experienced FGM with another 24,000 under 15 years of age deemed ‘at risk’.
Though widely and mistakenly viewed as an Islamic practice, FGM is actually practiced by many communities, including Christians, Jews, as well as Muslims. Religious roots of the practice are obscure and much controversy surrounds the religious scripts that ‘approve’ it. Circumcisers are most often women and community based, but there is an increasing trend noted by the World Health Organisation of health practitioners performing such procedures.
FGM affects an estimated 100-140 million women worldwide and is practised primarily in Africa and the middle east. It is an extremely harmful practice that has deep roots in culture and tradition and involves the removal of external female genitalia for non-medical purposes; the amount of removal depends on which type is practiced with type three being the most radical.
As global migration increases, the practice is becoming a problem in America and Northern Europe, especially with a rise in populations from Africa and the middle east. FGM has been picked up as a serious issue to be addressed by statutory agencies, most overtly in midwifery practice and in schools. At Birmingham and Solihull Women’s Aid (BSWA) we identified it as a gap when we discussed issues facing the women we work with.
The central issue with FGM is how to engage effectively with often hard to reach communities, and particularly with women who most need support. The subject is shrouded in secrecy, and although it is against the law in the UK, to date, there have been no criminal convictions.
If we are to understand what support is required from BSWA, we need to understand who is affected in Birmingham, the prevalence of the practice and the complex issues involved. A critical success factor early on in our work was employing a Somali worker with a sound understanding of the practice who was able to develop good relationships, listening and working with the community, and being sensitive to the wider issues faced by these communities. We had learnt lessons from working on domestic violence issues, and knew that community sensitivity was paramount. Balancing addressing this very serious issue, while ensuring that communities were not stigmatised, was foremost to our approach.
Our work was initially very problematic because most community organisations were led by men, and the issues they focused on were advice, employment and education – issues central to every newly arrived community. Our worker, Khadija Jaamac, adopted a fresh technique of finding African areas in Birmingham and Solihull and walking the shopping malls to find ‘natural’ places where women congregate. She discussed issues generally with shop keepers and women before touching upon her work. From this, women’s groups were formed, enabling awareness raising, training and discussions on health, religion, personal development and the law.
This approach led to nine community events on FGM at which we showed the film Africa Rising, directed by Paula Heredia, depicting the practice in many African countries, and highlighting ways in which the communities were acting to discourage it; development of four women’s groups in different geographical areas across Birmingham and two courses for women on health, child protection, leadership and organisation for women and youth with FORWARD, the leading FGM agency in the UK.
We were very successful in engaging with young people. Having trained young women, one young woman, Ayan Ali, worked with her father’s community group to organise an event on FGM. Another young woman, Sagal Warsam, developed her own group called NEAYA – the North East African Youth Group. They organised an event that attracted 60 young people from practicing communities in Birmingham, and Sagal reported that, “The event gave us the opportunity to participate and express our opinions and views about FGM and we enjoyed listening and debating with our audience who expressed a wide range of opinions. It was a fantastic opportunity not only to learn so many things about it, but we also had the chance to put everything we learned into practice through organising the event.”
Another woman who attended the event, Rian Sharif said, “The event was not only informative, it was interactive as well because we were able to share our insights and thoughts. Hearing other women recount their experiences of FGM was truly moving”.
The project also made women aware of the only FGM Clinic locally, the African Well Women’s Clinic. Khadija worked alongside the specialist midwife and offered support to women who approached the clinic. After the medical examination from a midwife, Khadija talked to the women individually about the law and discussed the wider consequences of female genital mutilation. She found that many women thought they had Type 1 FGM, and were very upset when they realized it was a more severe form they had had done. Women were not clear of the health consequences of the procedure because they had not realized that the lifelong heath problems they had suffered were a consequence of FGM. Khadija also discussed the issue with male partners and found that their views were also affected once they realised the consequences of the operation on their wives. Some men were ignorant of FGM altogether, but after the sessions, they often said that they did not want their daughters to have the operation.
We partnered with Options UK to recruit fifteen researchers from local practicing communities, and gave them training in participatory ethnographic evaluation research techniques. The evidence we gathered provided real insight into understanding the experience of FGM in Birmingham, and revealed that women were not aware of how widespread the practice was – most believed it was a local tradition. After our sessions, women recognised that it is indeed a child abuse issue – having previously viewing it in much the same as male circumcision. Many younger women also believed that FGM was declining, but this was contradicted by those who had arrived most recently - bringing with them stronger traditions and keeping the practice alive. Although there is good awareness that FGM is illegal in the UK, a lot of myths persist about why it is necessary, including that it is a religious practice. The biggest pressure to continue, as expected, is social pressure; most women wanted to see it end after this discussion but did not necessarily feel empowered to advocate this openly in the community, even if they did so in their own family. Women’s views included, “we don’t want to be stigmatised simply because we come from a country that practices FGM”; “we want to fight against FGM”; “it is only now we realise that FGM is child abuse, many people in our home country don’t realise that”.
The research helped to highlight areas with the highest concentration of practicing communities - essential in the current climate of diminishing resources because it allows us to decide where best to concentrate efforts in addressing FGM in Birmingham. Huge strides could be achieved in addressing FGM if statutory bodies agreed to undertake awareness raising of FGM, and training of professionals in GP surgeries, midwives and schools in these areas alone.
We found that women and young people were eager to discuss FGM once the initial barriers had been addressed and they felt comfortable with our organisation. The project has been very successful. After attending sessions with us, 80% of women, - from backgrounds as diverse as Sudan, Yemen, Eritrea, Gambia, Ivory Coast and Guinea - agreed that they would not undertake FGM on their own children, and would advocate against it within their family. We have now trained 57 women to be advocates in their own communities against FGM, and reached 580 women with the messages about the reality of the practice. As Khadija says, “I am helping women in the community, who are survivors of FGM, often for the first time, to talk about it openly and to support them emotionally. Women have understood more about their bodies and know how to access services – this is so important in fully understanding and coping with the consequences of FGM”.
What is heartening is the passion that women from the communities, old and young, feel for the subject of FGM, and their desire to address the issue in a positive way in their community. Once the women had more in-depth knowledge of female genital mutilations and it's grave lifelong consequences, the vast majority of them wanted to see the practice end.