• Female Genital Mutilation in Britain

    One of my proudest journalistic achievements is the investigation I did jointly with Mazer Mahmood into Female Genital Mutilation in Britain and how we uncovered three men who are prepared to conducts this horrendous procedure on young women in the UK. Because of increased awareness about this horror in some of the communities in which it occurs - primarily women from the Horn of Africa who have settled in the Uk - girls are being mutilated at younger ages; often between the ages of three and eight. The interview below is with Alison Byrne a specialist midwife in Birmingham who has seen the numbers of women presenting to her with FGM triple in the last decade.

    In a shiny car seat, immaculately swathed in co-ordinating pink blankets and hat a new-born baby girl is about to leave the maternity unit of Heartlands Hospital in Birmingham. Her proud mother’s eyes shine above her veiled face.

    Bordesley Green, is one of the most ethnically mixed parts of Britain’s second city, mosques and foreign grocers proliferate and the streets are full of saris and hijabs, capped Asian men and redbrick semis. Public notices in the hospital are written in several different languages. As a nation, we embrace diversity and celebrate it – but there are definite legal limits to our tolerance and this midwifery unit is leading the way in dealing with one of the most abhorrent and culturally sensitive practices of all: female genital mutilation (FGM).

    “It was in 2002 that we started getting an influx of women to the maternity unit here who had been cut” explains Alison Byrne, 42, a specialist midwife who has pioneered treatment for such women in the UK. In 2003, she saw 109 women with FGM, by 2010 that number had tripled to 317, last year she saw 318 and in the first months of this year she has already seen 105. “The women who present to me are all of child-bearing age between 16 and 40. The women from the Horn of Africa (Egypt, Sudan, Somalia, Eritrea) in my experience predominantly have Type3 FGM – that means all the external genitalia have been removed and the raw edges brought together. Some women are left with an opening the size of a matchstick through which to urinate and pass menstrual blood – as a result they get terrible infections, often bleed continuously for 28 days because it is so hard for fluids to escape, get terrible menstrual cramps and can take 20 minutes every time they urinate.”

    Penetrative sexual intercourse is of course impossible for such women: “I see some where in order for them to get pregnant some very active sperm must have been deposited near the tiny opening and swum up,” explains Byrne. Traditionally, she says, “It was a husband’s duty to open his wife on the wedding night. In some communities the man would cut her open and consummate the marriage and then wipe the blood of the knife on to his clothing and parade round the village. One woman told me how her husband had repeatedly tried to penetrate her night after night for three months before he achieved partial entry. The suffering these women have endured is unimaginable. I am humbled and impressed by their strength, good humour and dignity”.

    Often the women are entirely ignorant of their own anatomy – or even that it is unusual. Often Byrne has to show the women diagrams to find out what kind of FGM they have; “sometimes they don’t know what they have until I examine them and explain.”

    As Britain has accepted more refugees from FGM practicing countries the number of women presenting with the condition in Heartlands hospital, which is part of the Heart of England Foundation Trust, for instance, has tripled in a decade. Rates of FGM vary widely according to the cultural norms of tribe and country, but according to the World Health Organisation 90% of Egyptian women, 88%of Eritreans, 74% of Ethiopians, 78% of Gambians, 97% of Somalis, 90% of Sudanese, 95% of women from Guinea and 85% from Mali have suffered FGM. (But in Uganda and Cameroon it is around 1%). “In the last few years I have been seeing more women from The Gambia, they tend in my experience to predominantly have Type 1 FGM where the clitoris has been removed in the first year of life. I find women with Type1 FGM often present with high levels of psycho-sexual issues. “

    Type 2 is partial or total removal of the clitoris and the labia minorae with or without excision of the labia majore.

    In cultures that practice Type 3 FGM it can be done anytime between the ages of three and eight, or at the onset of puberty or as a right of passage to marriage. “No two women present with exactly the same genital geography; the cutting is not a precise science. Sometimes it would happen outside the back of a hut, with goats around and the child would be held, struggling, wriggling, screaming trying to escape while they were cut in unsterile conditions with a piece of glass or razor blade.” Over the years she has heard many women’s stories and witnessed their trauma – she offers them psycho-sexual counselling and support.

    “In these societies this is never spoken about, not even amongst the women. It is taboo. Often talking about it with me brings back upsetting memories. It can be very hard for the women to deal with it because usually it is the mother, the aunties, the grandmother, the women who love them most and that they most trust who have this done to them. These cultures see the cutting as an act of love, a preparation for the future, often a girl will only be able to make a good marriage if she has had it done. It is the women who do it and organise the process.”

    FGM is not a religious practice but a cultural one which predates Christianity and Islam by thousands of years. The most extreme form, Type 3, where the woman is ‘sealed’ is also known as ‘Pharonic circumcision’ – legend has it that the Pharoah’s wife had herself sewn up to prove that she would be faithful while he was away at war.

    “Before a woman with Type 3, who has been sewn up, can give birth she must be de-infibulated” explains Byrne. Deinfibulation is the process in which the scar tissue which has formed when the clitoris and soft tissue were cut out originally and then the lips of the vagina were sewed together (often they were pinned with thorns) is surgically cut open. The raw edges are over sewn so the woman is once again ‘open’ with the urethra and vagina exposed – allowing a normal birth and urination. Before midwives such as Byrne learnt such techniques, “Many hospitals were giving these women unnecessary caesarians because they didn’t know what to do,” explains Byrne. In traditional societies the women would have been cut open with a knife while in labour and restitched again afterwards.

    “I just try to give these women who come to me what everyone else expects as birth right,” Byrne says of the women she has ‘opened’. “The ones I have followed up have not been re-stitched, often they go on to have five or six new babies and being able to urinate normally and have normal length periods is a revelation; they stand and move completely differently. They have to adjust to a whole new kind of life – and, of course, they can have penetrative sex and in some cases under the scar tissue there can be remnants of the clitoris. Some of the women I have treated are delighted.”

    Hasseena Lockheart who has written extensively about women’s sexual experiences post FGM reports that some women have “cervical orgasms” rather than clitoral ones.

    Yet Byrne’s major concern is about what happens to the girl babies, born in Britain but into cultures where FGM is the norm. “After such a woman has given birth, the fact that she has FGM will be put on her notes and we also record that the little girl’s genitals are intact, in case there is a problem later on. But there are so many children who need supporting and could be at risk and awareness amongst the safeguarding professionals about FGM is very low. I’ve met doctors who say to me, “What is FGM?” I am concerned that the signs are being missed. This is a secret, silent phenomenon; no woman has ever just come out and told me she has it. There are no secrets between a woman and her midwife, but even so they are elliptical, embarrassed. Often a woman cannot talk about it directly. Some have told me how they have gone to the doctor, over and over again with a ‘headache’ hoping someone will examine them and help them, but the signs are missed.”

    Of even more concern to her is safeguarding the girl children of FGM women; in 2004, the International Centre for Reproductive Health estimated that in the UK around 20,000 girls in Britain aged under 16 were at risk (with 100,000 women in Britain having been effected). Given the increase in immigration from the 28 African countries that practice it, and the tripling in incidence that Byrne has seen over the past 10 decades, that figure could be far too low. Byrnes is also convinced that “girls are being cut in the UK, or taken back to their country of origin – but it is also happening privately on the black market in the UK”.

    “I am worried that the staff in Accident and Emergency departments, GPs, paediatricians, health visitors, school nurses don’t know enough about FGM to join the dots when it appears in front of them,” she says, running her hand anxiously through her thick, wavy red hair. Byrne believes the best way to protect these vulnerable girls is to raise awareness of what FGM is, that it exists in Britain and what the signs may be that a child is at risk. “If a young African girl is brought in with a urine infection to her doctor, or Accident and Emergency, or takes a long time urinating, then alarm bells should go off, the professionals around her should recognise that that might be symptomatic of abuse,” she says. She is particularly worried about young Gambian girls, “It is happening more actively in that community, there are current threats from current practitioners and less awareness amongst the women I talk to that cutting is illegal in Britain and that it comes with a hefty 14 year prison sentence. That needs to be much more widely talked about.” It would perhaps be more of a potent threat if in the 25 years the legislation has been on the statute book there had been a single prosecution: there hasn’t. It’s all very well for Britain to cite its laws (FGM is a criminal offence here and it is also a crime to take a child out of Britain for that purpose) and is outlawed under the European Court of Human Rights conventions on the rights of the child, but if we never prosecute anyone for practicing FGM, it’s not much of a deterrent.

    “The law is there to empower people to speak up and raise awareness, “ says Amber Rudd MP. “We know FGM is happening in Britain, as a society we should be doing everything we can to stop this dreadful, cruel barbaric act being carried out on any girl in Britain.”

    Schools, Byrnes believes, also have a crucial role to play. “If a teacher hears a primary school girl talking about how she is being taken home for a “special holiday” to “become a woman” then alarm bells ought to be ringing. But FGM is not on the curriculum for medical school training, or for social workers, or teachers and even for midwives it may only be covered in the inner city. There is very low awareness. We owe these little girls born here more than that.”

    The little pink bundle, carried out to the waiting taxi with so much pride is a British citizen; as a society we should do whatever it takes to ensure she makes it to womanhood intact – that is her birthright.







    1 Comment

    • 1. May 30 2012 3:44PM by Marianne Baker

      It is a travesty that our laws are not being properly enforced to protect girls from this horrific 'rite'. It's also shocking that the medical curriculum is not sufficiently educational about female OR male genitalia.

      It will be much easier to justify action against people performing this procedure and offering their children up for it when people take a stand against the equivalent procedures that we permit baby boys to suffer, simply because they have a penis instead and people think the foreskin is useless.

      The reality is that children - male and female, either way helpless in the hands of people with power and their parents who should be protecting them - are having unnecessary cosmetic surgery with potentially fatal risks and many more non-fatal effects forced upon them. No choice, no ability to go back. Justified how? Perhaps because of religion (not a valid excuse to perform FGM), perhaps because of ignorance of anatomical function or a cultural desire that says it's fine to deliberately try to impair sexual function.

      If we're going to protect girls around the world, we need to start protecting children, whatever the contents of their pants - those contents have a right to be left well alone, except in cases of medical necessity

      This is an excellent exposé for several reasons. People think FGM is something that happens in Africa and other developing countries. That it does happen in the UK, and in UK families must be widely publicised.

      Men and boys die because of genital cutting rituals worldwide too - whether it's in a poor village or an American (or UK) hospital, it happens. And every one is too many. And every defence of people's "right" to perform unnecessary genital cutting on their baby boys is fuel for people to defend their "right" to do similar to their girls. That is no right, but the child's right to their intact body most certainly is.

      Hopefully knowledge of the issue will inspire people to learn more and get behind the cause.

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