More than 22,000 FGM survivors have been identified by UK public health providers since 2015 – though newly-recorded cases are declining – a special report by The Ferret, an independent news website in Scotland, has found.
Female genital mutilation (FGM), which involves cutting or removing female genitalia for non-medical reasons, is a high-profile international issue and has has been described by the UN as a form of gender-based violence.
But comprehensive data on these practices is hard to find amidst inconsistent record-keeping and low reporting rates. In the UK, most of the cases identified in the data we found are from the National Health Service England.
The majority of these cases involve women and girls born outside of the UK – a finding that echoes previous 2012 research which estimated that as many as 137,000 FGM survivors live in England and Wales.
“All the available data suggest that numbers [of FGM survivors] are now very low among women born in England and Wales”, emphasised City University professor Alison Macfarlane, who co-wrote the 2012 report.
Women’s rights advocates hope this means that families from countries where FGM is more widely practiced are ‘breaking the cycle’ and getting closer to the UN sustainable development goal to end the practice by 2030.
In Bristol, a survivor who moved to the UK from Somalia, also described how attitudes towards FGM have changed in her own family and how a local charity Integrate has created space for youth activism against the practice.
Compared to a decade ago, when “no one was talking about FGM… So much has changed, and it’s survivors who are leading the work. That’s wonderful”, said Lisa Zimmermann, the director of the Bristol-based charity.
A spokesperson for NHS England, however, was cautious. “We cannot confirm that the number of girls born in the UK undergoing FGM is low as a result of changing attitudes, due to low reporting rates,” they said.
“No one was talking about FGM… So much has changed, and it’s survivors who are leading the work”
The UN further estimates that 68 million more women and girls are at risk of undergoing FGM before 2030, primarily in African countries including Somalia, Egypt, and Burkina Faso, as well as in Sri Lanka and Indonesia.
There are three different types of FGM, ranging from ‘Type 1’ which involves the partial or total removal of the clitoris, to ‘Type 3’ which removes the clitoris and labia, and narrows the vaginal opening.
“The law says FGM is violence against women and girls, and child abuse”, feminist activist, Nimco Ali, told The Ferret. She is a prominent British campaigner against the practice, who underwent it herself at age seven.
Laws on FGM do vary internationally, but criminalisation hasn’t stopped the practice in countries including the UK, which outlawed it in 1985 and later made it an offence to arrange these procedures outside the country.
There have been few prosecutions in the UK, and only one conviction earlier this year, meanwhile there have been a total of 21,510 newly-identified FGM survivors in England since 2015, according to NHS data.
Rahma*, one FGM survivor living in Bristol, described lying in bed in pain as a nine-year-old after undergoing the procedure in Somalia, and being told to press her legs together so her stitched vaginal opening could close.
As a teenager, she has had “painful and heavy periods where it is hard to go out”, a common consequence of FGM. “Every time my period is painful”, she said. “This never would have happened if I hadn’t got FGM done”.
Since April 2015, NHS England has been collecting quarterly data on FGM cases from GPs, hospitals and mental health services.
Their spokesperson described its ‘FGM Enhanced Dataset’ as “very powerful” and “the most comprehensive dataset that we have” that has already had “direct implications for the commissioning of services.”
As an example, they pointed to a new “model of care” reflected in the government’s September opening of eight walk-in ‘FGM clinics’ “to create attitudinal change within the community” and support survivors.
Between April and June 2019, 975 women and girls were newly recorded as having undergone FGM, most of whom were in London. The majority of these survivors were born in Africa, while only 65 were born in the UK.
There are significant limitations to this data, however. Newly-identified cases are often recorded during other healthcare appointments, which may happen years after a woman has undergone the practice.
More than 75% of the data collected came from women attending midwifery or obstetric appointments. But, significantly, women with insecure immigration status may be wary of attending NHS services and may never access them.
In Wales, separate NHS data shows that between 2016-18 a total of 465 newly-recorded cases of FGM survivors were identified by public health providers – the majority of whom were in the Cardiff area.
In Scotland, the Liberal Democrats recently used freedom of information requests to reveal 231 cases identified in Glasgow and Edinburgh in 2017-18.
In Northern Ireland, data collected by the BBC showed that 23 cases were identified between 2016-18, primarily in the capital Belfast.
The NHS data shows a drop of more than 30% in the number of newly-identified cases in England in the second quarter of 2019 (995) compared to the same period in 2015 (1,575).
There is further supporting evidence for declining numbers, and hope from rights advocates that migrant communities in the UK are ‘breaking the cycle’ with fewer of their daughters undergoing the practice.
As part of her research, academic Saffron Karlsen, from Bristol University, spoke with women in the city’s Somali community who she said “felt very strongly that their children should be protected from FGM”.
They were “very keen to be involved in working with different authorities and groups towards ending FGM,” she added. “They didn’t see FGM as an issue in their culture anymore… and FGM was now in the past.”
These perspectives are often overlooked, warned a report that Karlson co-authored this year, showing how safeguarding measures designed to protect girls from FGM had left communities feeling ignored and criminalised.
In Bristol, Rahma moved to the UK after undergoing FGM at the age of 9. Now 18, she recalls the day her aunt called a man to their family home in Somalia, and told her to lie on a table and open her legs.
“He was so old, I remember he couldn’t even see where he was cutting me”, she says, describing how the procedure was performed while her mother was at work, as she didn’t approve and felt guilty about it happening afterwards.
Now, other family members are also “very against” it, and she thinks most people in Bristol’s Somali community are too. Though “there’s a lot of work to do,” she adds, sitting in the offices of Integrate, a local charity.
Rahma says Integrate has helped her develop confidence to speak about her experience. The charity’s director, Lisa Zimmermann, also praises the “amazing young activists” she works with.
Now Rahma hopes to work in healthcare and help other women who have undergone FGM. But above all she wants the practice eradicated for good.
“I really, really hope that no one has to go through that kind of pain,” she tells me. “Hopefully we can all come together and fight this as a whole”.
* Some names have been changed to protect identities.