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The challenges in child health


Nurses are central to tackling FGM


Emily Twinch


For most parents, the thought of letting someone cut your child with a sharp instrument, let alone cut their genitalia, would be inconceivable. But for some it is a cultural practice – and one they must believe is necessary as it is still happening in the UK, despite being illegal. In 2020 there were 2,790 newly recorded cases of female genital mutilation (FGM) in England, which was a drop of 28% from 2019. But still 2,790 cases too many.

As our in-depth professional article and our piece on the public health role of midwives show, healthcare professionals have a central role in spotting the signs of where FGM has happened, and ideally where there is a risk that it might happen. Indeed, they have a legal duty to do so in the case of girls under the age of 18 years.

While FGM rates appear to have gone down during the pandemic, this might be more to do with its being more difficult to spot during lockdown than a true fall in the number of incidents. So it is even more important that nurses and midwives are attuned to the signs.

However, cultural and language barriers can make this difficult. Mothers who themselves were victims may avoid healthcare appointments if they feel they are seen as potential perpetrators on their daughters. So nurses must not only spot the signs of FGM but treat every possible case extremely sensitively, and use the right words to achieve the best outcomes for patients.

This, of course, is a lot to ask. Mandatory reporting of FGM was controversial before it took effect. Umbrella groups the Local Government Association and the Association of Directors of Children’s Services wrote to then minister for crime prevention, Lynne Featherstone – a staunch campaigner against FGM over the years – saying the move could create ‘confusion for both practitioners and victims’ and carried ‘significant risks’. But it did become law in the case of under-18s, and it is crucial that everything possible is done to prevent girls from being harmed by this terrible practice.

Many of the girls subjected to FGM are under the age of five, and not only face immediate physiological and physical pain, but also long-term effects, including epidermal cysts and renal damage. Help is at hand for nurses though: the RCN has guidance, which is signposted in our professional article, while last year the Government also issued guidance for professionals with a duty to report FGM.

The Coalition Government did make progress towards its goal of ending FGM. To quote Ms Featherstone, on International Day of Zero Tolerance to Female Genital Mutilation in 2019: ‘Female genital mutilation is child abuse, and now it is beyond all doubt that it is against the law in the UK.’ Nevertheless, the target remains some distance from being met and we must keep going.