Female genital mutilation - caring for patients and child protection
The UK Distribution and prevalence
In Britain, female genital mutilation is seen in some ethnic groups that have immigrated to this country, often as refugees. The main groups in the UK are from Eritrea, Ethiopia, Somalia and the Yemen. Dispersal of asylum seekers across the UK makes increasing numbers of doctors likely to come into contact with women who have been mutilated and girls who might be. It is important that all health professionals are aware of which groups are potentially at risk, so that when caring for a girl and her family who have racial or cultural links with countries where female genital mutilation is endemic, they are alert to the possibility of mutilation. In Britain the most common age for a girl to be mutilated is between 7 and 9 years.
In November 2000, the All Party Parliamentary Group on Population, Development and Reproductive Health acknowledged that there was a severe shortage of data about prevalence in the UK. One estimate suggests that 74,000 women in the UK have undergone genital mutilation and a further 7,000 girls under 17 are at risk.[Go to reference 18] The All Party Parliamentary Group recommended that funds should be allocated for the collection of data and subsequent research into the incidence of female genital mutilation in the UK, to be collated by the Department of Health. Such data should be incorporated into the Government’s core policies, including its strategy for sexual health.
Regulation
Female genital mutilation is illegal in England, Wales and Northern Ireland under the Female Genital Mutilation Act 2003 and in Scotland under the Prohibition of Female Genital Mutilation Act 2005. Both Acts make it an offence for any person:
(a) to excise, infibulate or otherwise mutilate the whole or any part of a girl’s labia majora, labia minora or clitoris; or
(b) to aid, abet, counsel or procure the performance by another person of any of those acts on that other person’s own body, or
(c) to aid, abet, counsel or procure a person to excise, infibulate or otherwise mutilate the whole or any part of her own labia majora, labia minora or clitoris.
Both Acts also make it a criminal offence in certain circumstances to carry out female genital mutilation abroad, and to aid, abet counsel or procure the carrying out of female genital mutilation abroad, including in countries where the practice is legal. The offence carries a maximum penalty of fourteen years imprisonment.
These prohibitions are not absolute, and both Acts permit surgical and obstetric procedures that may fall within these categories if they are carried out by an appropriately registered practitioner either during childbirth or for the physical or mental health of the patient. There has been limited clarification of the circumstances in which procedures falling within this definition might be necessary. However, valid exceptions to the prohibition on FGM are listed in the Explanatory Notes of both Acts and include surgery for gender reassignment, cosmetic surgery resulting from perceived abnormality, and operations to remove malignant tumours. [Go to references 21, 22] There has been little clarification of the circumstances in which FGM might be necessary for mental health purposes. It is clear, however, that in determining whether an operation is necessary for the mental health of a person, “it is immaterial whether she or any other person believes that the operation is required as a matter of custom or ritual”. [Go to references 23, 24]
In many communities, including those based in the UK, custom demands that a woman be re-infibulated after each childbirth. The Royal College of Obstetricians and Gynaecologists issued a press release in June 1993, to note that the agreed definition of the word infibulation is that it is a “stitching together of the labia”. Therefore, when an obstetrician is faced with the repair of the vulva of a woman who has delivered a baby vaginally following previous infibulation, it is illegal to then repair the labia intentionally in such a way that intercourse is difficult or impossible.
A person found guilty of an offence under either Act could be imprisoned for up to fourteen years. At the time of writing, however, there have been no prosecutions under the Act. The All Party Parliamentary Group on Population, Development and Reproductive Health regretted that there have been no prosecutions in the UK.
Two doctors have been found guilty of serious professional misconduct before the General Medical Council, however. The first of these, in 1993, involved a doctor who had performed female genital mutilation while knowing that it was illegal. The doctor was struck off the medical register but the police refused to prosecute. In 2000, another doctor was struck off for offering to carry out female genital mutilation.