Female genital mutilation: the case for a national action plan - Home Affairs Committee Contents

1  Introduction

1. The World Health Organization (WHO) defines female genital mutilation (FGM) as "all procedures involving the partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons".[1] It has four classifications:

·  Type 1 (clitoridectomy), which involves partial or total removal of the clitoris and, in rare cases, only the prepuce;

·  Type 2 (excision), which involves partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora;

·  Type 3 (infibulation), which involves narrowing of the vaginal opening through the creation of a covering seal, which is formed by cutting and repositioning the inner or outer labia, with or without removal of the clitoris; and

·  Type 4 (other), which comprises all other harmful procedures to the female genitalia for non-medical purposes, such as pricking, piercing or incision of the clitoris and/or the labia; stretching of the clitoris and/or labia; and cauterisation or burning of the clitoris and surrounding tissues.

2. FGM is usually carried out on girls between infancy and the age of 15, with the majority of cases occurring between the ages of five and eight. It is also occasionally carried out on adult women, for example, reinfibulation following childbirth, or where a woman is forced into the procedure by her husband after marriage. Though in some countries it is more likely to be carried out by a health professional, it is commonly performed by a traditional practitioner with no formal medical training, without anaesthetics or antisepsis, using knives, scissors, scalpels, pieces of glass, or razor blades.[2] Often the girl is forcibly restrained. Leyla Hussein, a survivor and campaigner, described to us her experience of being cut when she was eight:

    They brought this other man to hold me down. I remember just feeling ashamed because they were seeing my private parts. I think that is what I was worried about more than anything. He said, "We are going to give you an injection and everything will be fine. You won't feel a thing". I felt everything. I felt the injection. I felt being cut. I felt being sewn.[3]

3. For girls and women who undergo FGM the health consequences are often devastating. The immediate effects include severe pain, bleeding, shock, urine retention, infections, injury to neighbouring organs, and sometimes death from uncontrolled bleeding. Longer-term complications arising from Type 1 and 2 FGM include failure of the wound to heal, abscess formation, urinary tract infection, dermoid cysts, vulval adhesions, neuromas, and painful sexual intercourse. Type 3 FGM can result in any of the above complications, as well as reproductive tract infections, which can lead to pelvic inflammatory disease, dysmenorrhoea, chronic urinary tract obstruction, and urinary incontinence, as well as a range of other severe complications.[4] In addition, many women and girls experience long-term mental health problems, such as depression and post-traumatic stress.

4. The United Nations Children's Fund, UNICEF, estimates that 125 million women and girls worldwide have undergone FGM, the majority in a belt of 29 African countries that stretches from the Atlantic to the Horn of Africa. In Egypt alone, 27.2 million women and girls have undergone FGM, with 23.8 million in Ethiopia, and 19.9 million in Nigeria.[5] Prevalence rates vary significantly. In Somalia, Guinea, Djibouti and Egypt, for example, more than 90 per cent of the female population aged between 15 and 49 have been cut, whereas in Niger, Cameroon and Uganda it is less than two per cent. Prevalence may also vary greatly within countries, and can be more closely associated with particular ethnic groups. Overall, it is believed that up to 3 million girls are subjected to FGM every year.

5. The origins of FGM are complex and go back thousands of years. It is a cultural practice, which does not have any basis in religion, although there is a commonly-held misconception that it is a religious requirement. In practising groups it is rooted in patriarchy, and is seen as a rite of passage to adulthood and a prerequisite for marriage. For some African women, marriage and reproduction are the only means of ensuring economic security and social status. Without undergoing FGM, a woman may be denied the right of marriage, with the potential consequence of casting her out from society. The Hawa Trust, an organisation which works with local communities in Hackney to tackle FGM, told us:

    The young uncircumcised girl is still considered today as a second-class citizen, impure, a bilekoro, according to a typical expression in Mali and Guinea. Such a young girl can neither marry nor even be allowed to prepare the family meal until she agrees to be circumcised.[6]

6. Many adherents to the practice believe that FGM has an important role in preserving virginity and chastity before marriage. After marriage, it is assumed to ensure the faithfulness of the woman to her husband. Other commonly-held, erroneous beliefs include the suggestions that the procedure enhances fertility, increases sexual pleasure for the man, and ensures the health of babies. Notwithstanding such mistaken beliefs, families within practising communities often feel a strong sense of obligation to conform, fearing that failure to do so will lead to social exclusion, ridicule, and an inability to find a suitable marriage partner for their daughters. In short, it is a powerful and deeply rooted social norm founded on the subordination of women. As Nimco Ali, a survivor and campaigner, told us:

    It is about controlling women's sexuality and women's aspirations to do anything. If a woman is in pain […] and she is scared about what is going to happen to her, then ultimately she is never going to attain her full potential.[7]

7. Internationally, FGM is recognised increasingly as a severe form of violence against women and girls. This was also acknowledged in the overwhelming majority of evidence received as part of our inquiry.[8] The 1993 UN Declaration on the Elimination of Violence against Women defines FGM as a form of violence against women. Article 5 of the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa requires states to prohibit traditional practices that are harmful to women, including FGM, and to take all necessary measures, legal or otherwise, to protect women from FGM. In recent years an increasing number of countries have legislated against the practice. Indeed, FGM is now prohibited to varying degrees in 24 out of 29 of the countries in Africa and the Middle East where it is most prevalent.[9] However, there is a growing consensus that legislation is just one part of a range of interventions governments must undertake to end the practice.

8. FGM is a severe form of gender-based violence, and where it is carried out on a girl, it is an extreme form of child abuse. Everyone who has a responsibility for safeguarding children must view FGM in this way.

FGM in the UK

9. FGM has been a criminal offence in the UK since 1985. Its existence in the UK is largely as a result of migration from practising countries. Its prevalence has been difficult to determine because of the hidden nature of the crime. The most widely cited estimates are from a study published by FORWARD UK in 2007.[10] Using 2001 census data, this estimated that approximately 66,000 women between the ages of 15 and 49 in England and Wales had undergone FGM. This figure includes women who were cut before entering the country, and women who have been cut since becoming residents. The study also estimated that at least 24,000 girls under the age of 15 were at high risk or may have already undergone FGM, Type 3. This included girls born abroad who had migrated to England and Wales, and girls born here to mothers from practising countries. In addition, the study estimated a further 9,000 girls were at high risk or may have already undergone FGM, Type 2.

10. Because of increased migration from practising countries, notably Somalia and the rest of the Horn of Africa, as well as population growth over the last decade, it is likely that the prevalence of FGM and the number of girls at risk have increased significantly since the 2007 study.[11] A more recent study using 2011 census data estimated that around 170,000 women and girls were living with FGM in the UK, and that 65,000 girls aged 13 and under were at risk of being cut.[12] Leyla Hussein and Nimco Ali from the Daughters of Eve told us they believed the true figure for the number of girls at risk was likely to be more than triple that estimated in the 2007 study.[13]

11. There is also a lack of data on the geographical spread of girls at risk of FGM. The 2007 study found that, between 2001 and 2004, maternities to women who were likely to have undergone FGM accounted for 6.3 per cent of maternities in inner London and 4.6 per cent in outer London. In the London boroughs of Southwark and Brent, almost one in ten maternities were to women likely to have undergone FGM. Outside of London, areas that had a prevalence of two per cent or more included Cardiff, Manchester, Sheffield, Northampton, Birmingham, Oxford, Crawley, Reading, Slough and Milton Keynes. Our written evidence also highlighted Leeds and Bedford as areas with large potential at-risk groups. The Agency for Culture and Change Management, a non-governmental organisation, noted too that the Government's dispersal policy will have created large migrant communities in small towns, some of whom are from FGM-practising countries.[14] Even then, as FORWARD argued, those at risk are not a homogenous group, and include British citizens born in the UK, migrant groups, asylum seekers, refugees and students from affected communities.[15] There are also varying trends within communities. For example, the Tackling FGM Initiative told us that dialogue on FGM within the Somali community had resulted in support for the practice waning amongst settled members in recent years.[16]

12. The paucity of data extends also to where the cutting takes place. Anecdotal evidence suggests it is common for girls subjected to FGM to be taken back to their country of origin during the holidays to undergo the procedure. But there is also evidence that FGM takes place in the UK.[17] The Metropolitan Police, for example, told us information it had gathered from communities suggested that cutters were operating in London.[18] However, there is no reliable information on the extent to which FGM is taking place in this country as opposed to abroad. Furthermore, FORWARD noted that community members reporting FGM were more likely to say that it happened abroad before they became a British citizen to avoid the risk of further investigation.[19]

13. The Home Office and the Metropolitan Police are part-funding a new study into the prevalence of FGM in England and Wales using data from the 2011 census, which will update the figures in the 2007 study, and provide new estimates broken down by local authority area. The results of this work are expected this summer. In addition, earlier this year the Department of Health announced that all acute hospitals would begin reporting information about the prevalence of FGM within their patient population each month from September 2014.[20] The Parliamentary Under Secretary of State for Public Health told us the new reporting arrangements would give, for the first time, a clear picture of what is happening in the UK.[21]

14. Even conservative estimates of the number of girls at risk of FGM indicate that it could be one the most prevalent forms of severe physical child abuse in the UK. In two London boroughs, for example, almost one in ten girls are born to a woman who has undergone FGM, and are therefore at risk of being cut themselves. Yet, apart from a small number of high-level statistical analyses and anecdotal evidence, we have very little information on the children who are most at risk, and even the extent to which the cutting is occurring in this country or by taking girls abroad. Meanwhile, as many as 170,000 women in the UK may already be living with the life-long consequences of FGM. We welcome efforts by the Government and others to draw a more accurate picture. However, even in the absence of precise data, it is clear that the extent of the problem is very significant, and therefore needs to be matched by a response by all those who have a responsibility for safeguarding children that is similar in scale.

Recent developments and our Report

15. Until recently, there has been relatively little public awareness of FGM in the UK. In 2000 the All Party Parliamentary Group (APPG) on Population, Development and Reproductive Health made 35 recommendations in respect of legislation, education policy, community-based work, and health strategy, though the majority of these were never translated into policy action.[22] In 2003 the law against FGM was strengthened by extending its coverage and increasing the potential punishments, though until 2014 there had not been a single prosecution. In the last two years there has been a significant increase in media and parliamentary awareness of the issue. Campaigns by The Evening Standard, the Guardian, and The Times have created much greater public awareness of FGM, highlighting gaps in the provision of services, the lack of sufficient data, and the absence of any FGM-related prosecutions. The APPG on FGM has also been successful in pushing the issue up the political agenda.

16. Underpinning greater political and media interest in FGM has been the tireless work and lobbying of third sector groups such as Equality Now, Daughters of Eve, FORWARD, Integrate Bristol, and others, as well as a small number of health professionals who see day-to-day the consequences of FGM. Efforts by these organisations and individuals have created a step-change in awareness and finally forced the Government, the Crown Prosecution Service, and others to strengthen their response. Indeed, earlier this year the Prime Minister announced that he will host a major event in July 2014 on tackling FGM, as well as early and forced marriage. The summit will consider the need for action both domestically and internationally.

17. Although it is outside the scope of this inquiry, we appreciate that FGM is unlikely to end in the UK before it is abandoned by practising communities in Africa.[23] To help achieve this, the Department for International Development has recently provided £35 million over five years to support the Africa-led movement to end FGM.[24] Whilst we welcome this funding we note, however, the conclusion of the International Development Committee in 2013 that "the UK's credibility in calling to end the practice overseas is undermined by the failure to tackle the problem at home".[25]

18. Evidence we received from the Bar Human Rights Committee and the Equality and Human Rights Commission (EHRC) argued that the state has a duty of care to protect women and girls from FGM.[26] Furthermore, the failure of the state to do so represents a breach of the UK's international law obligations under the Convention on the Elimination of All Forms of Discrimination against Women 1979, and the UN Convention on the Rights of the Child 1984.[27] The EHRC also told us the fact that FGM is prohibited by law is not in itself sufficient to discharge the state's responsibilities. A number of witnesses told us that a comprehensive national action plan led by the Government was the only way to tackle FGM in the UK effectively.[28] This call has also received the backing of 109,000 people who have signed the e-petition set up by Leyla Hussein and Efua Dorkenoo calling on the Government to put in place such a plan.

19. The failure to respond adequately to the growing prevalence of FGM in the UK over recent years has likely resulted in the preventable mutilation of thousands of girls to whom the state owed a duty of care. This is a national scandal for which successive governments, politicians, the police, health, education and social care sectors all share responsibility. We pay tribute to the efforts of a small number of individuals and organisations who have worked to raise public awareness of FGM and the impact it has on those who have undergone the procedure. Many of those campaigners who have spoken out have had to withstand criticism and ostracism by those in their own communities who do not wish to see an end to the practice. We also acknowledge the work of the Evening Standard, The Guardian, and The Times in raising public awareness of FGM in the last year. The Government has started to take action, and we welcome the stated commitment to end FGM in a generation. It must now implement a comprehensive and fully-resourced national action plan for tackling FGM. The plan should provide clear leadership and objectives, setting out the standards expected of all relevant bodies, and to which they will be held accountable. It should incorporate a number of interlinked aspects, including:

·  the achievement of successful prosecutions for FGM;

·  working with professionals in the health, education, social care and other sectors to ensure the safeguarding of at-risk girls;

·  changes to the law on FGM;

·  improved working with communities to abandon FGM; and

·  better services for women and girls living with FGM.

20. We consider each of these in the subsequent chapters of this Report. Finally, we welcome the Prime Minister's planned summit on FGM and forced marriage. We urge him to consider the recommendations in this Report. We welcome the fact that the summit will reflect the international dimension of the problem, and we hope that the relevant heads of government of affected states are invited to attend. We believe the Government should aspire to the UK being a world leader in the policy response to FGM.

1   World Health Organization, Female genital mutilation, Factsheet No. 241, February 2014 Back

2   FGM 0048 (Equality and Human Rights Commission), para 6 Back

3   Q2 (Leyla Hussein, Daughters of Eve) Back

4   Tackling FGM in the UK: Intercollegiate recommendations for identifying, recording and reporting, November 2013 Back

5   UNICEF, Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change, 2013 Back

6   FGM 0017 (Hawa Trust) Back

7   Q19 (Nimco Ali, Daughters of Eve) Back

8   For example, FGM 0003 (Buckinghamshire County Council), para 1.1, FGM 0004 (NSPCC), para 2, FGM 0008 (Bar Human Rights Committee), para 26, FGM 0010 (28 Too Many), para 2.1, FGM 0011 (International Association of Women Police), para 10, FGM 0015 (Movement for Justice), FGM 0022 (Intercollegiate Group on FGM), para 1, FGM 0024 (Victoria Climbié Foundation UK), para 1.2, FGM 0025 (Metropolitan Police), para 1, FGM 0028 (Rights of Women and Asylum Aid), para 11, FGM 0029 (Government), para 1, FGM 0048 (Equality and Human Rights Commission), para 5, and FGM 0052 (Royal College of General Practitioners), para 5 Back

9   UNICEF, Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change, 2013 Back

10   Efua Dorkenoo, Linda Morison and Alison Macfarlane, A statistical study to estimate the prevalence of female genital mutilation in England and Wales, 2007 Back

11   FGM 0029 (Government), para 14, and FGM 0049 (Alison Macfarlane and Efua Dorkenoo), para 1.3 Back

12   Julie Bindel for the New Culture Forum, An Unpunished Crime: The lack of prosecutions for female genital mutilation in the UK, 2014 Back

13   Q15 (Leyla Hussein and Nimco Ali) Back

14   FGM 0018 (Agency for Culture and Change Management) Back

15   FGM 0047 (FORWARD), para 25 Back

16   FGM 0026 (Tackling FGM Initiative) Back

17   For example, FGM 0010 (28 Too Many); Q18 (Leyla Hussein) and Q333 (Professor Janice Rymer, Royal College of Obstetricians and Gynaecologists) Back

18   Q214 (Metropolitan Police Service) Back

19   Q234 (FORWARD) Back

20   FGM 0029 (Government), para 24 Back

21   Q267 (Parliamentary Under Secretary of State for Public Health) Back

22   Q47 (FORWARD), para 6 Back

23   Q269 (Minister of State for Crime Prevention) Back

24   FGM 0029 (Government), para 5 Back

25   International Development Committee, Violence against Women and Girls, Second Report of Session 2013-14, HC 107  Back

26   FGM 0008 (Bar Human Rights Committee), and FGM 0048 (Equality and Human Rights Commission), para 19 Back

27   FGM 0008 (Bar Human Rights Committee), para 11-12 Back

28   FGM 0010 (28 Too Many), para 3.4.1, FGM 0012 (Professor Lisa Avalos), para 12, FGM 0026 (Tackling FGM Initiative), FGM 0047 (FORWARD), para 47, and FGM 0048 (Equality and Human Rights Commission), para 5 Back

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© Parliamentary copyright 2014
Prepared 3 July 2014