johncameronIn this guest blog the NSPCC’s John Cameron writes about the charity’s new helpline offering advice and support to anyone concerned about girls in danger of female genital mutilation and the crucial role that health professionals can play in protecting children from this:

The NSPCC recently set up a special helpline to protect girls from female genital mutilation. We did so after discovering that in the last two years more than 70 women and girls sought specialist NHS treatment every month. One was aged just seven.

Carried out in some African, Asian and Middle Eastern communities in the UK, female genital mutilation involves the partial or total removal of the external female genital organs. It can happen at any time before a girl or young woman is married or pregnant, but most typically occurs between the ages of four and 10. Sometimes even babies are victims.

As some health practitioners will have seen first-hand, this illegal, life-threatening initiation ritual leaves its young victims in agony and with long-term physical and psychological problems that can continue into adulthood.

Victims can also go on to suffer chronic vaginal and pelvic infections, menstrual problems, kidney damage, cysts and abscesses, pain during sex and infertility problems. In some cases they will die.

Child abuse not culture

Female genital mutilation is child abuse and illegal and must be treated as such. However the reality is that it is a very complex and sensitive issue and we understand some professionals may feel unsure or conflicted about reporting cases they come across.

For example a 15-year-old may present with repeated urinary tract infections, and on examination it becomes clear she has had female genital mutilation. However the patient may accept this as a normal part of her culture and not want it reported as abuse. And as the procedure is irreversible a health professional may feel there is nothing they can do to help.

However what health professionals need to understand is that those who have suffered female genital mutilation often don’t know it is abusive and harmful because they have been told by their own family that it is in their best interest. There is also huge pressure from their community to keep quiet with some people even being threatened with violence if they speak out.

This is why professionals who come into contact with these communities have such a vital role to play in reporting cases of female genital mutilation.

While too late to reverse what has happened to these children there is still an opportunity to provide health care for the consequences of the abuse. Also, there may be younger girls in their families that can still be protected if the abuse is reported and investigated.

In the school summer holidays there will be GPs and nurses seeing girls from these communities for immunisations before they travel abroad. They need to be aware that some of these girls are being taken to other countries where FGM is practised to have the procedure carried out and for their wounds to heal before they return to the UK.

Child protection must take precedence
Again I realise the dilemma. Professionals will be reluctant to accuse families of taking their daughter abroad for female genital mutilation. And of course, not every family will be doing this. But where there is risk, child protection concerns must take precedence.

Having an honest conversation, saying you are aware they are travelling to a country where female genital mutilation is practised, explaining it is illegal to take a girl abroad to be cut, and setting out the health consequences may save a child from unimaginable pain and possibly death.

Some families may not know that female genital mutilation is illegal and openly admit to it. They may try and sway professionals, saying it is a cultural, or even religious requirement, and their daughter will otherwise be an outcast. Their arguments can seem persuasive. However, nothing changes the fact that this is child abuse and can never be condoned. It is worth noting that no religion requires female genital mutilation. Where it takes place it is a clear case of oppression of women – nothing more, nothing less.

If following a conversation about female genital mutilation there is doubt about a child’s safety, concerns should be reported to police and children’s services so they can investigate and protect that girl.

Midwives in particular will have opportunities to engage with mothers from the start. As well as providing the expectant mother with the additional care she will need, they will be able to speak with her about the health consequences and the fact that it would be illegal to practise it on her child. Of course this will not be an easy conversation to have, and is one that must be handled sensitively. If midwives would like advice around this in addition to their own organisation’s support systems our new helpline is a place they can call.

Working together to protect girls from female genital mutilation
The NSPCC’s FGM helpline was set up after working closely with professional bodies including the Royal College of Midwives, and community groups that campaign to protect girls at risk. There was unanimous agreement that there should be a single contact point to provide a source of support to anyone worried about female genital mutilation.

Helpline counsellors can provide information to professionals, talk through the situation and help them take action to protect these children.

They are also there to speak with members of communities in which this abuse is practised. We know it is vital to engage with communities about the harm female genital mutilation causes and work with religious leaders to dispel the misconception that it is a religious requirement. We hope our helpline can play a part in changing attitudes by providing advice, support and information.

We would be grateful if professionals working with these communities can let people know they can call us anonymously for information. They can also contact us, again anonymously, if worried about a girl at risk, and we can make a referral to the police and children’s services to protect that child.

Female genital mutilation cannot and must not be justified in the name of culture. It is child abuse. It is illegal. And it must be stopped. Working together I believe it can be.

If you are worried that a child may be at risk of FGM, you can contact the NSPCC’s free 24 hour helpline anonymously on 0800 028 3550 or email fgmhelp@nspcc.org.uk