Bristol's coordinated approach involves the affected communities at all levels of education
According to the latest figures published by the Health and Social Care Information Centre, hospitals in England discovered around 15 cases of FGM per day during November. Over the course of the month 466 cases of FGM were reported.
Roughly a third of NHS trusts did not submit their findings to the HSCIC, meaning that the real number is likely to be even higher. Despite the prevalence of the practice – estimates suggest around 20,000 girls are at risk in England and Wales – noone has ever been convicted of performing it in the UK.
There is currently one trial underway, that of London doctor Dhanuson Dharmasena who is accused of replacing a woman’s FGM stitches after they were torn in labour.
The difficulty of securing a prosecution can be attributed to a number of factors; low levels of investigation by police, the difficulty of building evidence when faced with silence from the community, and perhaps most worryingly, the fact that frontline practitioners often hesitate to make referrals because they are afraid they will be accused of racism or cultural insensitivity.
Underpinning all this though, is the fact that there is a very low level of self reporting by victims of FGM. This is not surprising given that they are usually very young when the procedure takes place and are taught that FGM is a positive, necessary thing. Furthermore, it is usually instigated by people who they know love and care for them, so it can be hard to conceptualise it as abuse.
This is why local councils need to do far more to install education initiatives in every school. Simply prosecuting is not enough; if the myths surrounding FGM are not disbanded then girls risk being stigmatised by their community if they do not undergo it. FGM should be featured on every school curriculum, and be taught to both boys and girls from a young age.
For a long time Bristol has been leading the way in tackling FGM. The city, which has a large Somali community, has garnered attention for its coordinated and community-led approach.
The city council’s public health team leads what is known as the Bristol Model, a Delivery and Safeguarding Partnership comprised of a network of statutory agencies, volunteer groups, charities and community leaders.
Nimko Ali, the founder of the Daughters of Eve campaign, has praised Bristol’s approach, in which teachers, NHS staff, police and survivors all work together to spread awareness of the dangers of FGM, and to help those at risk find appropriate support.
In 2013, the North Bristol NHS Trust asked midwives to check all of their patients for FGM and 117 cases were found. All schools in Bristol have been offered in-house FGM awareness training.
The Integrate Bristol project was awarded £19,807 in government funding for its flagship FGM initiative. This funding has helped to train 10 young people from communities affected by the practice to travel to schools and colleges across the country. It also works with mothers who are considering FGM for their daughters, and with young men to raise awareness of the reality of FGM procedures.
In 2013 the Bristol Community Rose Clinic opened, with the aim of providing care and support for women experiencing problems as a result of undergoing FGM. In November the clinic won an award for excellence in healthcare. Crucially, women from the local community were involved in developing the service at the Rose Clinic. It is vital that services are designed with advice from women who understand the rhetoric surrounding the practice.
In 2007 I worked at a health centre in Bristol where the majority of patients were from Somali or South Asian backgrounds. There were not even leaflets about FGM in the surgery. Today that health centre has a specialist drop-in clinic for girls and women worried about the issue.
It will be a while before we can numerically depict the benefits of Bristol’s campaigns – it may not be until we see the next generation of young women choosing not to ‘cut’ their daughters. But in Bristol, people are talking about FGM at all levels.
In 2013 the Bristol Safeguarding Children Board estimated that up to 2,000 girls in the city are at risk of FGM. There are similar estimates for Manchester and higher ones for Leeds. Meanwhile it was estimated that nearly 4,000 girls were admitted to hospitals in London between 2009 and 2014, having already undergone the procedure.
That is 4,000 women already mutilated for life, facing a future of severe pain and health risks. This is no longer a marginal issue – it is a human rights disaster happening in the middle of London. It needs to be brought into the very mainstream of public health education, and Bristol has provided a model of how to do that.
Ruby Stockham is a staff writer at Left Foot Forward. Follow her on Twitter
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