FGM – Don’t scapegoat the medics

I am an obstetrician and gynaecologist and I have practised in the NHS for many years, as well as working in the private sector. I am frankly alarmed by what is happening with the FGM safe guarding issue. I think it will prevent young women seeking medical help when they desperately need it, help to intimidate and criminalise medics in the UK and completely fail to tackle the problem, which is largely an imported problem from Muslim communities in countries across Africa.

First let’s take a look at the facts. I will quote directly from government publications

Since 31 October 2015 there is a mandatory reporting duty which requires regulated health, social care professionals and teachers in England and Wales to report ‘known’ cases of FGM in under 18s which they identify in the course of their professional work ( NHS or private) to the police. (Section 5B of the 2003 Act1)

 This means if you are concerned that a child (a girl under 18 ) may have had, be at risk of FGM or you observe physical signs that appear to show FGM, you must call 101 (the police non-emergency number) to make a report along with your local safeguarding lead. Record all your decisions and actions. This must be done as soon as possible and at least before the end of the next working day. The police may return your call.

You will have to provide the girl’s name, date of birth and her address. Yours and your safeguarding lead contact details.

A genital examination is not required unless this is already part of your role. You do not need to be certain FGM has been performed to make a report. A formal diagnosis will be sought later.

So far, so laudable, but have they really thought this through?

Firstly, what do they want to achieve?

The vast majority of girls and women who undergo FGM have had the procedure carried out in their countries of origin. There is simply no proof that there are vast numbers of backstreet cutters circumcising girls in Wandsworth.

They are taken to Lagos, Mogadishu or Cairo by their family members during the ‘cutting season’ in the summer holidays and brought back when they have time to heal.

We will be reporting crimes over which we have no jurisdiction – quite simply, we can’t get the perpetrators, unless we want to convict the victim’s own relatives.

And most victims of FGM do not want to bring down shame and the full force of the law on their relatives. So women under the age of 18 from the communities that practice FGM will stop coming to surgery, full stop. They will learn that the law has been changed and they are likely to be reported. Since they won’t be sure if a visit will necessitate an intimate examination, they will simply avoid all doctors. They certainly won’t be coming to a gynaecologist. Since many Somalian girls marry very young and have children before they are 18, this is going to make things very dangerous for them

Secondly, I am going to think twice about seeing any Somalian, Nigerian and Egyptian female under the age of 18. I just don’t want to deal with the fallout when I find FGM, which I inevitably will. I can’t help recall the awful situation that Dr Dhanuson Darasama went through when he was accused of carrying out FGM when helping a Somalian woman deliver her child. He simply put a stitch in the wound site to stop the bleeding after a forceps delivery. It took 30 minutes for a jury to acquit him but he lost two years of his life and his reputation was shredded. What this tells me is avoid, avoid, avoid.

Yes, it is a form of abuse, but FGM is carried out on the vast majority of girls in these countries. I have already decided to stop seeing any patient under the age of 18 in my private practice.

Crazily, the law also requires doctors to report situations when they find girls  with intimate tattoos and genital piercings – remember these may be 16 and 17 year olds who are old enough to marry and sign up for the military.

Thirdly, the cost of all this is terrifying. I estimate that it is going to cost around £1m for every conviction brought about by this new law. That could save a lot of children from being stamped to death, starved and beaten by abusive parents who are not being given the oversight and support they need by a stretched social services.

And FGM, which involves removing the external genitalia, is an appalling thing, but is rarely fatal. Have we got our priorities right here?

I think a powerful lobby has jumped on this issue and turned a minority concern into a wrecking ball that will cause widespread damage to the medical community and patients who need our help.

The real focus should be getting the communities involved to change their minds about FGM, through education and guidance, direct to the heart of the problem. It seems to me that the people who govern us are so worried about being seen as racist, they would rather target the hapless doctors, nurses and teachers who are trying to pick up the pieces.