Act now on female genital mutilation – research makes case for independent commissioner

Fewer than 500 Female Genital Mutilation (FGM) Protection Orders have been made in England and Wales between their introduction in April 2015 and September 2019. In the same period 22,500 girls and women have been recorded by NHS Digital as having undergone FGM.

This gap has prompted medical and legal experts to call for a female genital mutilation (FGM) commissioner to examine the effectiveness of these orders in protecting girls and women.

Worldwide, there has been an overall decline in FGM’s prevalence over the last 30 years but UNICEF estimates there are around 200 million women and girls living today who have been subject to FGM. Immediate health consequences include severe pain, significant risk of damage to the urinary tract, bleeding, infection and possible death. Long-term effects include chronic pain, painful intercourse, urinary incontinence, recurrent urinary tract infections and complications of childbirth such as obstructed labour, still birth, severe tears, infection and haemorrhage.

FGM has been illegal in the UK since 1985. To date, however, there has only been one successful conviction for FGM in the UK and it’s known that many women and girls in the UK have undergone or are at risk of undergoing FGM.

In 2015, UK laws were extended to introduce FGM Protection Orders (FGMPOs) which can be sought through a Family Court and can include conditions such as ordering travel bans or prohibiting contact with people who could become involved in committing FGM against the child at risk.

But the low levels of applications for FGMPOs may indicate a lack of awareness among the public and professionals about the legal protection that is available, the researchers say in a paper published in the British Journal of Midwifery.

Professor Andrew Rowland, Consultant in Children’s Emergency Medicine at North Manchester General Hospital and Honorary Professor (Paediatrics) at the University of Salford, carried out the research with Dr Joseph Home and Staff Nurse Kimberley Walton, also from North Manchester General, Professor Felicity Gerry QC, a leading barrister who is also Professor of Legal Practice at Deakin University in Australia, and Dr Charlotte Proudman, barrister and junior research fellow at Queen’s College, Cambridge.

Professor Rowland said: “It remains unclear what impact, if any, FGMPOs are having upon the protection of women and girls at risk of FGM.

It is concerning that the number of cases of FGM recorded in the NHS far exceeds the number of applications for FGMPOs. This may suggest that there are some women and girls who have undergone FGM who might have been able to have been protected by a FGMPO if an application has been made to the court.

He urged frontline health professionals, including nurses and midwives, to be vigilant and make sure they have processes in place to report and record FGM, as well as having information available about FGMPOs to be able to discuss with patients. This would add to current NICE guidance in relation to decisions by health professionals to report child abuse and neglect.

Professor Gerry QC also raised concerns about courts’ reluctance to make FGMPOs, particularly when the risk is abroad, rather than in England and Wales.

She said: “We have heard of applications for FGMPOs being dismissed because the risk of FGM was abroad and the child didn’t have secure immigration status. There is also evidence that local authorities can be reluctant to make applications when a child doesn’t have British citizenship, even if they are a habitual resident. This is manifestly unjust.”

The paper puts forward four key proposals:

1. An FGM Commissioner should be appointed and carry out a full, independent evaluation of mandatory reporting of FGM and the effectiveness of FGM Protection Orders, including to lead public health interventions to prevent FGM.
2. Healthcare professionals should be able to access training about FGMPOs to give them the confidence and competence to have discussions with at-risk girls and women.
3. There should be more work to raise public awareness about the protections available from FGM. This could include forms that ask about FGM at every health appointment to capture those at risk of FGM or who are concerned about FGM, who do not report specific symptoms.
4. Local authorities should be encouraged to apply for FGMPOs where the child’s immigration status is insecure and they are at risk of removal to their country of origin where they might be subject to FGM.

The call for an independent FGM Commissioner follows previous work by Professor Rowland and Professor Gerry which highlighted a huge mismatch between reports of FGM data obtained from NHS Digital and data obtained from police authorities. This suggested that the true scale of FGM in England and Wales is not being properly investigated because of a lack of consistent, high-quality data.

Professor Rowland added: “Further research in this area would be welcomed, particularly investigating to what extent an FGMPO actually protects an individual women or girl from FGM.”

• North Manchester General Hospital is run by Manchester University NHS Foundation Trust as part of a management agreement prior to its formal transfer from the Northern Care Alliance NHS Group (NCA), the overall body that runs Salford Royal NHS Foundation Trust and The Pennine Acute Hospitals NHS Trust. North Manchester’s research programme is run by the NCA Research & Innovation department.