Female Genital Mutilation. Affected Communities in Birmingham

Transcription

1 Female Geital Mutilatio Affected Commuities i Birmigham Author: Shaista Gohir OBE Lead Researcher: Shahi Ashraf MBE Jue 2016

2 Dedicatio This report is dedicated to the brave survivors of female geital mutilatio / cuttig (FGM / C) who helped us with our research. Despite their paiful memories these survivors had the courage to share their experieces with us. We thak them for their participatio because without their support, the research would ot have bee possible. Their accouts ad their views will hopefully cotribute towards chagig attitudes i FGM / C affected commuities ad to dimiish ad evetually elimiate the practice of FGM / C. Together we look forward to a future free of FGM/ C ot just i the UK, but also across the world. 2016, Muslim Wome s Network UK. All rights reserved. The cotets of the report are the sole property of Muslim Wome s Network UK. No part of this report may be reproduced or trasmitted i ay shape or form or by ay meas icludig writte, oral, electroic, mechaical, photocopyig, recordig or otherwise, without prior writte permissio of Muslim Wome s Network UK. 66

3 Cotets Muslim Wome s Network UK page Ackowledgemets 4 About Muslim Wome s Network UK 5 1. Itroductio Mai Aim ad Objectives of the Research What is Female Geital Mutilatio? Prevalece of FGM FGM ad the Law FGM Affected Commuities i Birmigham Police Ivestigatios ad the Birmigham Cotext Methodology Data Collectio Safeguardig Limitatios of the Research Research Fidigs - Procedure for FGM Primary Istigators of FGM Locatio ad Method Type of FGM Age Whe FGM Performed Evidece of Girls Udergoig FGM Research Fidigs - Cosequeces of FGM Effects o Physical Health Psychological Effects Sexual ad Relatioship Effects Social Effects Research Fidigs - Reasos for FGM Research Fidigs - Role of Religio Is FGM Cosidered Islamic? Religious Texts Used to Justify FGM Role of Islam to Challege FGM Research Fidigs - Social Attitudes Attitudes of Wome Attitudes of Me Attitudes of Boys Attitudes of Girls Coclusio ad Recommedatios Coclusio Recommedatios 44 Appedix 1 - Wome Survivors (Case Studies) 46 Appedix 2 - Wome who have ot had FGM (Case Studies) 54 Appedix 3 - Wome s Focus Group 57 Appedix 4 - Me from FGM Affected Commuities 58 Bibliography 60 66

4 Ackowledgemets Cotributors, Advisers ad Supporters We would like to thak the followig people ad orgaisatios; without them this research would ot have bee possible: ROSA (The UK fud for Wome ad Girls), which fuded the research. Although this documet is a output from Rosa s FGM Small Grats Programme. The views expressed are ot ecessarily those of ROSA. Shaista Gohir OBE, MBE (Chair of MWNUK) who oversaw ad assisted with the research, aalysed the data ad authored this report, all of which was i her volutary capacity. Shahi Ashraf MBE who was the lead researcher who coducted the vast majority of the research. She maaged to reach out to ad idetify survivors of FGM. The survivors of FGM who trusted us to share their very persoal ad traumatic experieces ad their views o the issue. The schools i Birmigham that ivited us to raise awareess of FGM ad eabled us to survey childre o their views regardig this issue, particularly St. Albas Academy who also partered with us to deliver a coferece o FGM. The me ad faith leaders from FGM affected commuities who shared their views. The wome who did ot have FGM but wated to help shed light o the issue from their perspectives icludig why they had ot udergoe FGM. Those who helped us to fid case studies ad itroduce us to survivors ad provided spaces to meet them. Board ad staff of Muslim Wome s Network UK. All of those who read the draft report ad provided valuable feedback ad guidace ad especially Saria Khalifa, Commuity Developmet Officer, Rosa (The UK Fud for Wome ad Girls). FORWARD ad Maria Maria Foudatio for their doatio to fud the desig ad prit of this report. We are also grateful to all those who have idirectly supported the project icludig West Midlads Police. 4 Female Geital Mutilatio - Affected Commuities i Birmigham

5 Muslim Wome s Network UK About Muslim Wome s Network UK Muslim Wome s Network UK (MWNUK) is a atioal Muslim wome s orgaisatio i Britai ( We are a small atioal charity (o ) that works to improve the social justice ad equality for Muslim wome ad girls. Our membership also icludes me ad wome of other faiths / o faith who support our work. We fid out about the experieces of Muslim wome ad girls through research ad helplie equiries. We idetify policy ad practice gaps ad use this iformatio to iform decisio makers i govermet as well as iformig our commuity campaigs. We also develop resources ad trai wome so they are better aware of their rights. We have a separate website for our atioal helplie ( that provides advice ad support o a rage of issues some of which iclude: domestic violece, forced marriage, female geital mutilatio, sexual abuse ad discrimiatio. The impact of our work is particularly felt i reducig the vulerability of Muslim wome ad girls, decreasig the prejudice they face, ad givig them a greater access to rights ad services - all of which allow them to cotribute to society like ay other citize. We are also creatig a critical mass of voices to ifluece chage with more wome beig cofidet to challege discrimiatory practices withi their commuities ad i society ad to ifluece policy makers. 5

6 1. Itroductio 1. 1 Mai Aim ad Objectives of the Research The aim of this research was to icrease the uderstadig of the issue of female geital mutilatio (FGM) i Birmigham by fidig out the views of wome, childre ad me from FGM affected commuities ad use the isights to be able to better challege tolerace of this practice ad build awareess. Aother objective was to uderstad the impact o survivors ad what support was eeded for them or those at risk ad whether there were issues beig overlooked by curret service provisio. 1.2 What is Female Geital Mutilatio? Female Geital Mutilatio (FGM) is sometimes referred to as female geital cuttig (FGC). Some people also refer to FGM/C as female circumcisio - but circumcisio is a iappropriate term as it implies that it is the equivalet to male circumcisio suggestig that cosequeces are far less severe tha is the actual case. However, the term FGM is ot always uderstood by idividuals i practicig commuities; they are more likely to use the term circumcisio or relevat terms i their ow laguage e.g. the Somali term for FGM is gudi, the Sudaese term is tahur ad the Arabic term is khita (FORWARD, 2013). FGM is defied by the World Health Orgaisatio (WHO) as the rage of procedures which ivolve the partial or complete removal of the exteral female geitalia or other ijury to the female geital orgas whether for cultural or ay other o-therapeutic reaso. WHO has classified FGM ito four types (WHO, 2014): Type 1 Clitoridectomy Partial or total removal of the clitoris (a small, sesitive ad erectile part of the female geitals) ad, i very rare cases, oly the prepuce (the fold of ski surroudig the clitoris). Type 2 Excisio Partial or total removal of the clitoris ad the labia miora (the ier lips that surroud the vagia), with or without excisio of the labia majora (the outer lips that surroud the vagia). Type 3 Ifibulatio Where the clitoris ad labia miora are completely removed ad the vagial opeig is stitched or arrowed leavig oly a small opeig (1-2 cm) for the passage of urie ad mestrual blood. Type 4 Other All other harmful procedures to the female geitalia for o-medical purposes, e.g. prickig, pichig, piercig, icisig, scrapig ad cauterisig the geital area. 6 Female Geital Mutilatio - Affected Commuities i Birmigham

7 Muslim Wome s Network UK 1.3 Prevalece of FGM Some statistics are give below to highlight the extet of the problem i terms of wome ad girls who are livig with FGM or at risk of it i the UK, Europe ad worldwide a. Global Statistics The Uited Natios Childre's Fud (UNICEF), estimates that more tha 125 millio wome ad girls worldwide have udergoe FGM, the majority livig i 29 coutries i Africa ad the Middle East. The list of these 29 coutries with their prevalece rates ca be foud i Figure 1). Although o atioal represetative data o FGM are available for coutries icludig Colombia, Jorda, Oma, Saudi Arabia ad parts of Idoesia ad Malaysia, evidece suggests that FGM is beig carried out there too. It is also practised i pockets of Europe ad North America, which, for the last several decades, have bee destiatios for migrats from coutries where the cuttig of girls is a age-old traditio (UNICEF, 2013). Figure 1 Percetage of girls ad wome aged who have udergoe FGM, by regio/ coutry. Source: UNICEF - Uited Natios Childre s Fud. Female Geital Mutilatio/ Cuttig: A statistical overview ad exploratio of the dyamics of chage. New York: UNICEF; Prevalece of FGM 0-9% 10-29% 30-49% 50-69% 70-89% 90-99% This map is stylised ad ot to scale 98% 96% 93% 91% 89% 89% 88% 88% 76% 76% 74% 69% 66% 50% 44% 38% 27% 27% 26% 24% 23% 15% 13% 8% 4% 4% 2% 1% 1% Somalia Guiea Djibouti Egypt Eritrea Mali Sierra Leoe Suda Gambia Burkia Faso Ethiopia Mauritaia Liberia Guiea-Bissau Chad Côte d Ivoire Keya Nigeria Seegal Cetral Africa Republic Yeme Uited Republic of Tazaia Bei Iraq Ghaa Togo Niger Cameroo Ugada 5 7

8 b. Europea Statistics Europea Parliamet estimates that 500,000 wome ad girls are livig with FGM i Europe with aother 180,000 at risk each year (Europea Parliamet, 2009). c. UK Statistics A estimated 137,000 wome ad girls with FGM, bor i coutries where FGM is practised, were permaet residets i Eglad ad Wales i From 1996 to 2010, 144,000 girls were bor i Eglad ad Wales to mothers from FGM practisig coutries. It was estimated that 60,000 of these girls aged 0-14 i 2011 were bor to mothers who had FGM (Macfarlae ad Dorkeoo, 2014). The Health ad Social Care Iformatio Cetre (HSCIC) is collectig data o FGM withi Eglad o behalf of the Departmet of Health (DH) ad NHS Eglad (NHSE). Accordig to the October to December 2015 statistics, there were 1,316 ewly recorded cases of FGM reported, with 2,238 total attedaces where FGM was idetified or a procedure for FGM was udertake (HSCIC, 2016). No reliable estimate of prevalece of FGM i Scotlad is available. A prelimiary aalysis of 2011 cesus data by the Scottish Govermet oted the umber of residets bor i Africa had doubled ad estimated that from , 2403 girls were bor i Scotlad to parets from FGM practisig coutries (Scottish Refugee Coucil, 2014). 1.4 FGM ad the Law FGM is a form of child abuse ad violece agaist wome. It was made illegal over 30 years ago by the Female Circumcisio Act i However families were bypassig the law by takig girls abroad to have the procedure. The Act was therefore replaced by the Female Mutilatio Act 2003, which made it illegal to take wome ad girls overseas for the purpose of FGM. As the law oly applied to UK atioals or permaet UK residets, it was stregtheed by the Serious Crime Act 2015 to also iclude people who are also habitually residet i the UK (but are ot UK atioals or permaet UK residets). FGM has also bee ulawful i Scotlad sice 1985 ad a covictio ca also result i a priso setece of up to 14 years. FGM Protectio Orders The Female Geital Mutilatio Act was ameded by sectio 73 of the Serious Crime Act 2015 to iclude FGM Protectio Orders, which offers the meas of protectig actual or potetial victims from FGM uder the civil law. The Orders came ito force o 17 July 2015 ad apply to Eglad, Norther Irelad ad Wales. Breach of a FGM Protectio Order is a crimial offece carryig a setece of up to five years i priso. As a alterative to crimial prosecutio, a breach could be dealt with i the family court as a cotempt of court, carryig a maximum of two years imprisomet. FGM Protectio Orders cotai legally bidig coditios, prohibitios ad restrictios to protect the perso at risk of FGM ad may iclude: Cofiscatig passports or travel documets of the girl at risk ad/or family members or other amed idividuals to prevet girls from beig take abroad. Orderig that family members (or other amed idividuals) should ot aid aother perso i ay way to commit or attempt to commit a FGM offece, such as prohibitig brigig a cutter to the UK for the purpose of committig FGM. Bedfordshire Police obtaied the first FGM order i the same moth the orders came ito force. They seized the passports of two girls to prevet them from beig take abroad to udergo FGM (Rawliso, 2015). 8 Female Geital Mutilatio - Affected Commuities i Birmigham

9 Muslim Wome s Network UK Madatory Reportig of FGM The Female Geital Mutilatio Act 2003, was ameded by sectio 74 of the Serious Crime Act 2015, to iclude madatory reportig to police by regulated health ad social care professioals ad teachers if: They are iformed by a girl uder the age of 18 that she has udergoe a act of FGM. They observe physical sigs that a act of FGM may have bee carried out o a girl uder the age of 18. The legal duty came ito force o 31 October Note: NHS cliical staff must also record i patiet healthcare records whe it is idetified that a patiet (eve if they are over 18 years of age) has udergoe FGM. 1.5 FGM Affected Commuities i Birmigham Birmigham is the most ethically diverse city i the UK with people of White, Asia ad Black ethicity represetig 68%, 20% ad 7% respectively (Birmigham Health ad Wellbeig Board, 2012) ad icludes sigificat populatios of FGM affected commuities: Accordig to the Birmigham Violece Agaist Wome Strategy (Birmigham Violece Agaist Wome Board, 2013) five years data up to 2013 showed Natioal Isurace Number registratios i Birmigham for people from 17 differet coutries where FGM is practiced. The iformatio curretly i the local Joit Strategic Needs Assessmet (JSNA) shows that there are a umber of Birmigham residets bor outside of the UK i coutries where FGM is practiced such as Somalia, Keya ad Nigeria where FGM prevalece rates are 98%, 27% ad 27% respectively (UNICEF 2013). Accordig to the Office for Natioal Statistics of the estimated Somali-bor migrats residig i the UK, approximately 7765 live i Birmigham. This is the secod largest populatio after Lodo. The prevalece rate for FGM i Somalia is 98%. The 2011 cesus also idicated that there are over 10, 000 people i Birmigham described their ethic group as Arab most of whom are of Yemei backgroud (give their log established history i the city). The prevalece rates for FGM i Yeme are over 19%. Although ethicity aloe does ot idicate that girls bor i these commuities have had or will udergo FGM, health data does raise cocers because wome sufferig from FGM are presetig themselves at hospitals i Birmigham. For example, i 2011, Birmigham s Africa Well Wome s Cliic (Heart of Eglad Foudatio Trust) treated wome who had udergoe FGM who were from 12 coutries of origi. The largest groups came from Somalia, followed by the Gambia, Eritrea ad Suda. Accordig to their data they had 318 FGM referrals ad the wome had udergoe types 1, 2 ad 3 FGM. The umbers of babies bor to mothers who have udergoe FGM is also cotiuig to rise across the city. For example, Birmigham Wome s Hospital NHS Trust reported betwee Jue ad December 2011 that there were 63 births by wome who had experieced FGM; 21 wome were Somali, 13 Yemei, 5 Sudaese, 4 Eritrea, plus ie other ethicities i smaller umbers. Accordig to Heart of Birmigham PCT a estimated 916 girls bor i Birmigham betwee 2003 ad 2009 were at risk of FGM. However these figures did ot iclude ewly arrived childre (Birmigham Violece Agaist Wome Board, 2013). Also ew research coducted by City Uiversity Lodo ad Equality Now shows that Birmigham has oe of the highest rates of FGM outside Lodo with prevalece rates ragig from 12 to 16 i every 1000 wome havig bee cut (Macfarlae ad Dorkeoo, 2014). 9

10 Collectively such data does idicate that FGM is a cocer i Birmigham ad girls bor to mothers who have udergoe FGM may be at sigificat risk of FGM. Eve girls who are bor to mothers from FGM affected commuities who have ot had FGM could also be at risk from exteded family e.g. auties ad gradparets who may support the practice. Birmigham City Coucil data locally idicates that i Birmigham upwards of 5,000 girls erolled i school betwee the ages of 5 ad 18 come from FGM practicig coutries (West Midlads Police ad Crime Pael, 2015). It is therefore very importat to uderstad the attitudes of childre, me ad wome from these commuities, particularly the Birmigham Somali commuity (give its size ad the fact it is a deeply etreched practice i Somalia with its extremely high prevalece rates). Fidigs ca help to uderstad the challeges to abadoig the practice of FGM. Isights to experieces of survivors ad commuity attitudes could also provide guidace to commuity orgaisatios ad frot lie professioals / agecies workig to prevet FGM. 1.6 Police Ivestigatios ad the Birmigham Cotext Despite the fact that FGM is illegal i the UK, o oe has bee covicted for the practice. The first ladmark prosecutio took place i Jauary 2015 agaist two me, oe of whom was a doctor, but they were foud ot guilty (Laville, 2015). I 2012 West Midlads Police arrested oe doctor ad oe detist i Birmigham after a article i the Suday Times claimed they had caught the me offerig FGM for two girls aged 10 ad 13 (Mahmood ad Mills, 2012). Although the charges were dropped Ali Mao-Aweys was struck off the medical register i 2014 (BBC News, 2014) ad the Geeral Detal Coucil struck off Omar Sheikh Mohamed Addow the previous year (Dowlig, 2013). It is alarmig that there may be a tiy miority of medical professioals from FGM affected commuities who could be willig to perform FGM. Not oly is it agaist the law but they are also givig the false perceptio that medicalisig the practice makes it acceptable. Local police statistics also idicate the occurrece of FGM. West Midlads Police have revealed they dealt with 70 cases betwee Jauary ad July 2015, which has icluded the arrest of a ma for arragig for his 15-year-old daughter to udergo FGM (West Midlads Police, 2015). This is higher tha i previous years where it had ivestigated 49 suspected offeces betwee Jauary ad Jue For example, 41 cases were recorded i 2013, 25 cases i 2012 ad 8 i Give these statistics ad the fact that some girls i Birmigham are clearly at risk of FGM, we also attempted to fid out about people s attitudes to reportig cocers durig our research. 10 Female Geital Mutilatio - Affected Commuities i Birmigham

11 Muslim Wome s Network UK The West Midlads Police Crime Pael The West Midlads Police Crime Pael lauched a iquiry i 2014 to fid out what the Police ad Crime Commissioer ca do to facilitate itegrated workig betwee agecies to prevet ad respod to FGM i the West Midlads. A rage of orgaisatios were ivited to give evidece betwee 24 November 2014 ad 19 Jauary The iquiry highlighted that accordig to official statistics from acute hospitals i the seve West Midlads districts (Birmigham, Covetry, Dudley, Sadwell, Solihull, Walsall ad Wolverhampto), betwee September 2014 ad March 2015 there were 632 ewly idetified cases of wome ad girls who had udergoe FGM. However, they had ot bee cut recetly ad it is likely that they were cut before they lived i the UK ad were seekig medical support, such as for childbirth. This is importat iformatio because it is usually the girls whose mothers have bee cut who are felt to be at ay risk. The West Midlads Police Crime Pael Report made 5 key recommedatios that were shared widely such as with NHS Trusts, Cliical Commissioig Groups, Safeguardig Childre Boards ad Directors of Childre s Services ad Public Health. These were: 1. Educatig Commuities Chage the midset of commuities through a educatioal campaig by workig with parets through schools ad supportig those already speakig out o the issue. Also esure whe a girl is bor to a mother who has udergoe FGM that appropriate steps are take to esure the family is made aware that it is both illegal to perform FGM ad its cosequeces. 2. Educatig Practitioers Esure good quality traiig for practitioers so they uderstad risk ad the role they eed to play i protectig girls. 3. Havig Cosistecy Across the Regio Esure agecies across the regio lear from each other ad that regioal best practice is developed. 4. Prosecutig Gather itelligece ad detect practice of FGM locally ad idetify those who may be practicig FGM ad take actio such as civil remedies (e.g. FGM Protectio Orders) ad take steps to protect girls at risk. 5. Providig Therapy Esure therapeutic eeds of survivors of FGM are met, as curretly there is little evidece of such support beig made available. 11

12 2. Methodology 2.1 Data Collectio Give the size of their populatios, the two largest FGM affected commuities i Birmigham are Somalis ad Yemeis (see Itroductio). Durig the research we therefore tried to reach out ad particularly seek survivors from these two commuities. Table 1 shows the ethic groups of the survivors who we spoke to together with prevalece of FGM i their coutries of origi. Of the 16 survivors we iterviewed, almost half (i.e. 7 participats) were of Somali backgroud. The other wome who shared their stories were of the followig ethicities: Eritrea, Djiboutia, Sierra Leoea, Egyptia, Nigeria, Sudaese, Gambia ad Yemei. Their case studies ca be foud i Appedix 1. Table 1: Ethicity of survivors iterviewed ad prevalece ad type of FGM practiced i their coutries of origi / birth Ethic Group of Iterviewees practicig commuities i Birmigham Percetage of wome aged who have had FGM i coutry of origi * Percetage of girls aged who have had FGM i coutry of origi * Egypt x Eritrea x Djibouti x Gambia x Nigeria x Sierra Leoe x Somalia x Suda x Yeme x * Source : ad DHS ad MICS, Despite the sigificat size of the Birmigham Yemei populatio, we foud it difficult to speak to wome from this commuity. Although oe youg woma shared her story, it was extremely difficult to fid wome willig to speak about FGM. We evetually maaged to speak to small group of six wome (of Egyptia ad Yemei heritage) through a Arabic speakig iterpreter. However, we were oly able to do this because the wome were attedig a separate gatherig. We persuaded a few of them to speak to us afterwards i a focus group. The wome were i their 50s, 60s ad 70s. Some ackowledged that they had also udergoe FGM but disclosed very limited details give the presece of other wome. 12 We targeted the followig groups for our research: Survivors of FGM Wome who did ot have FGM Me from FGM affected commuities School pupils (boys ad girls) Female Geital Mutilatio - Affected Commuities i Birmigham

13 Muslim Wome s Network UK We coducted the research through oe to oe iterviews, a focus group ad questioaires ad maaged to gather data through the followig: 30 oe to oe iterviews - 16 survivors, 8 wome who did ot have FGM ad 6 me from FGM affected commuities 1 focus group with Egyptia ad Yemei wome 560 Questioaires aimed at girls aged 16 years ad uder of which 77 were idetified as beig filled i girls from FGM affected commuities (based o their ethicities) Workshops with 120 boys aged 16 ad uder of which approximately 40 were idetified from FGM affected commuities (based o their ethicities) Durig the research iterviews ad awareess raisig sessios the participats were iformed of the legal status of FGM; where to get further support ad help; limits of cofidetiality (duty to report risk of harm ad disclosures); ad that FGM is ot sactioed by religio. Oe to Oe Iterviews As the lead researcher (who was checked through the Disclosure ad Barrig Service) workig o this project was herself ot from a FGM practicig commuity, we were aware this could be a barrier for egagemet ad trust. She therefore spet the first two moths attedig traiig courses to gai kowledge of the issue ad local commuity evets to build liks with wome ad me from FGM affected commuities to idetify idividuals for oe to oe iterviews. Durig etworkig at evets ad meetigs, idividuals were asked if they were willig to participate i our research. A sowball approach was adopted where prelimiary research iterviewees were asked for other cotacts that may be able to assist with the research. Evidece was gathered either by speakig to people face to face or via telephoe iterview. As the subject matter was very sesitive ad persoal, a umber of the iterviewees felt apprehesive sharig their idetity ad provided iterviews aoymously. The iterviews were coducted aloe uless the participat wated someoe preset. The iterviews were also semi-structured because it was evidet that may would fid it difficult to share their views opely. We tried to fid out the followig durig the iterviews: Backgroud iformatio - ethicity, age, faith, how log they had bee livig i the UK FGM procedure practiced - type, locatio, age etc. Cosequeces of FGM Reasos used to justify the practice icludig role of religio Istigators / facilitators of the practice Attitudes towards the practice icludig willigess to challege ad report it The level of details provided by participats varied cosiderably depedig o how comfortable they felt sharig iformatio. For may this was the first time they had spoke about their experieces of FGM i such depth. I this report ot all details associated with each iterview have therefore bee provided both to protect idetities ad also to esure the accouts were ot too legthy. 13

14 Data Collectio Through Survey Questioaires We also wated to speak to childre from FGM affected commuities. However, this is a difficult group to reach particularly for oe to oe iterviews. So we sought their views through aoymised questioaires after deliverig FGM awareess raisig workshops coducted i three secodary schools (two girls schools ad oe mixed geder school). These workshops ad surveys were ot specifically aimed at childre from FGM affected commuities but to etire classes to avoid stigmatisatio ad bullyig. Basic demographic iformatio that was collected through the survey (ad iformatio from school staff) helped us to idetify childre from FGM commuities ad oly their questioaires were aalysed for the research. We asked the childre to give us feedback o the workshops ad their views o whether: they were willig to ask for help if they or someoe they kew was at risk of FGM; if they kew someoe that had FGM or whether they themselves had it; if they were willig to disclose or report cocers ad who they would speak to. After the workshops iformatio o reportig ad where to get help was give ad ay safeguardig cocers raised with the safeguardig lead. The aoymous surveys were also shared with West Midlads Police so they could use the fidigs for their research. Focus Groups The focus group was used to primarily target Yemei wome because they are a hard to reach group. The discussio cosisted of itroducig the topic ad facilitatig a ope discussio, which icluded probig questios. The most sigificat commets they made are listed i Appedix Safeguardig The research posed a umber of risks so we put measures ito place to mitigate them as follows: Ayoe takig part i the research could be stigmatised as a result. We esured that their iterviews were coducted i a safe space agreed with them ad their iterviews were aoymised. Survivors of FGM beig re-traumatised by recallig their experieces. We iformed them how to access cousellig services. However, these were ot specialist FGM oes but geeric oes. We also ecouraged them to oly disclose what they felt comfortable with. Idetifyig childre at risk of sigificat harm or who had udergoe FGM. Whe such risks were idetified, child safeguardig procedures were followed. 14 Female Geital Mutilatio - Affected Commuities i Birmigham

15 Muslim Wome s Network UK 2.3 Limitatios of the Research This qualitative research was coducted o oly a limited budget; we oly had resources for a researcher to sped oe day a week o the collectig data. Some of the research had to be coducted durig additioal volutary time while the report was writte completely i volutary time. This meat limitatios i terms of applyig a systematic methodology ad havig to use a multiplicity of methods. The research was also affected by the followig limitatios: The reach of the ivestigatio was limited to the etworks ad coectios we made durig the research, as liks to FGM commuities prior to the startig the study was miimal. All the participats for the oe to oe iterviews idetified as beig Muslim, which meas we did ot have represetatio from other faiths. Despite the sigificat Yemei populatio i Birmigham we struggled to reach them. 15

16 3. Research Fidigs - Procedure For FGM 3.1 Primary Istigators of FGM It was evidet from the iterviews that wome, (particularly the elder geeratio) were the mai istigators of FGM (see table 2). Eve i oe case where the youg woma did ot have FGM, she explaied that her mother did try ad bribe her ad her sisters to have it doe (Case Study 8 - Appedix 2). Table 2 Appedix 1 Case Study 1 Case Study 2 Case Study 3 Case Study 4 Case Study 5 Case Study 6 Case Study 7 Commets Regardig the Istigators of FGM The survivor explaied that a old woma ad her gradmother came to the house ad her gradmother told her that she would be cleaed. The survivor said that if she had daughters the the elders would pressure her ito gettig the girls to have FGM The survivor described how her mother, her auties ad the the cutter lady gathered aroud her ad that she remembered there were 8-10 ladies. The survivor recalled how her mother took her to the village ad the the wome took her ad the other girls to the bush to get cut. The survivor described how she was take to a room by her mother ad held dow by ladies. The survivor explaied it was wome who led her (alog with other girls) to the ceremoy (for trasitio from childhood to womahood) by wome. The survivor said that her father was agaist the cuttig so her mother carried it out while he was away. Case Study 10 The wome told the survivor that she was goig to become a woma. Case Study 11 Case Study 12 The mother of a survivor explaied how her mother i law persuaded her husbad to take their daughter back to Gambia. Durig the visit the mother i law subjected her daughter to FGM (without permissio). The survivor s step mother ad gradmother wated her to be cut ad arraged it despite her dad beig agaist it. Case Study 13 The survivor ow resets her mother for puttig her through FGM. 16 Female Geital Mutilatio - Affected Commuities i Birmigham

17 Muslim Wome s Network UK Although we did ot fid ay evidece i the case studies to suggest that me were the mai istigators, there were idicatios that some me are supportive of the practice. For example, i Case Study 8 (Appedix 1) the survivor s mother had decided with her father that it was goig to happe. I Case Study 11 (Appedix 1), the iterviewee s husbad had take their daughter to Gambia (agaist her wishes) where she was cut because of the gradmother. The research showed that the me cosidered FGM a woma s busiess ad it appears that they are ofte ot ivolved i the decisio to have it carried out or the actual procedure itself. I fact there was sigificat evidece that may me i the study opposed it. For example, 6 me who were agaist FGM were willig to be iterviewed for our research (Appedix 4). Also the survivor i Case Study 7 (Appedix 1), said her father was agaist it so her mother carried it out while he was out for most of the day. She said whe he foud out, he early divorced her mother over it. Aother two wome said they had ot bee cut because of their fathers who were agaist the practice (Case Study 1 ad 3 Appedix 2). Wome therefore eed to be equipped to be more resiliet to pressure from their ow peer group particularly the older geeratio who are ofte highly respected ad me ca play a role i challegig the practice (as discussed further i Chapter 7). 3.2 Locatio ad Method The wome gave differig levels of details about the procedure because they geerally felt awkward ad embarrassed to talk about it. From the various accouts give, it was geerally a older woma from the commuity who performed the procedure without ay aaesthetic. Prior to the procedure some described beig asked to have a bath to esure they were clea ad give ew clothes ad presets. Some recalled sigig ad dacig too. Whe the time came they were held dow by a umber of other wome ad the cut. May said they screamed because the pai was so severe ad some recalled seeig lots of blood ad beig terrified. Afterwards the legs were boud ad the pai would last for days ad they were give little food or water for about a week. Oe survivor recalled havig the procedure doe three times (Case Study 7 - Appedix 1) because she kept opeig up as it was ot doe properly i the first place, which prologed her agoy. 15 of the survivors iterviewed directly had the procedure performed i their coutries of origi before arrivig ad settlig i the UK. However, the Yemei girl who was aged 17 (Case Study 15 - Appedix 1) had her FGM procedure i Saudi Arabia as her family lived there for a umber of years before movig to the UK. 17

18 Although most of the survivors had their FGM performed by older wome i their coutries of origi without aesthetic, some evidece emerged there may be a tred towards medicalisatio of the procedure by those who may be cotiuig the practice i the UK. Families may be ivolvig health professioals because they may believe it makes FGM less harmful to health or to that it makes it less detectable. Evidece icluded iterviewees beig aware of ivolvemet of medical professioals ad families takig childre to hospitals i the Middle East to have it doe Oe participat had heard that girls used to be take to other UK cities such as Sheffield ad Hull to get it doe but ow girls are beig take to Dubai or Egypt so it ca be doe uder aesthetic. She also remembered oe childhood fried beig take to Oma to have FGM. (Case Study 9 - Appedix 1) Oe participat said: There is some private cliic i Lodo owed by a Arab that was doig it. I eve heard about a relative, who was i her 20s ad had ot had it doe but wated it. She wet to a GP that was also from the same backgroud ad asked him if he would do it for her. This was i aother city outside of Birmigham but she did ot disclose locatio or whether this relative maaged to have FGM. She herself had a medical procedure i Saudi Arabia before her family settled i the UK. (Case Study 15 - Appedix 1) Oe participat explaied how she ad her sisters were bribed by her mother with moey to agree to have FGM i Dubai. However, upo arrival at the cliic the appoitmet had to be rescheduled ad they had to retur to the UK without havig the procedure carried out (Case Study 8 - Appedix 2) Oe Yemei lady i her 50s from the focus group thought that that FGM was acceptable providig it was medicalised ad said that she was aware of the practice cotiuig i certai parts of Yeme. Oe participat believes some families may be takig girls to have FGM doe i Middle Easter coutries because it is carried out i a sterile eviromet such as i a hospital or cliic. (Case Study 1 - Appedix 1) It appears that there may therefore be a very small miority of medical practitioers such as doctors from FGM affected commuities who may be illegally offerig FGM services. Perhaps the two medical professioals arrested i 2013 i the city of Birmigham (as highlighted i Chapter 1) was ot surprisig. The idetity of such health professioals who provide illegal services is likely to be passed aroud by word of mouth. This meas there will be people i the FGM affected commuities with a awareess of who these professioals are. It is therefore importat that people are ecouraged to whistle blow ad report ay medical practitioers they suspect of cooperatig i the practice of FGM. As people will be reluctat to report, they should be made aware of how they ca report aoymously. Those who wat to cotiue practicig FGM will ot just be takig girls to their coutry of origi. The research has highlighted that operatios are also beig performed i the Middle East. However, the police iitiatives at airports that iclude distributig iformatio o legal ad health impacts of FGM curretly ted to focus o outboud flights to coutries of prevalece i Africa. Perhaps awareess raisig targetig outboud flights to Dubai ad Saudi Arabia should also be cosidered give that they are popular travel destiatios (for holiday ad religious purposes respectively) ad also provide medicalised FGM services. 18 Female Geital Mutilatio - Affected Commuities i Birmigham

19 Muslim Wome s Network UK 3.3 Type of FGM Almost half of the survivors either did ot kow, were usure or did ot wat to disclose which type of FGM they had udergoe. However, about oe third (6 survivors) had the most ivasive form of FGM, type 3 (see table 3). This idicates that sigificat umber of girls i Britai may be at risk of this severest form of FGM ad also livig with its cosequeces. Table 3: Number of Survivors by FGM type FGM TYPE Number of Survivors Usure / Not disclosed / Did ot kow 6 A couple of the survivors (Case Studies 7 ad 9 - Appedix 1) metioed that some families were ecouragig their daughters to pich themselves as a alterative to types 1,2 ad 3 FGM. Pichig is used as a method to elogate the girl s labia miora, which would be classified as type 4 FGM. Families may be resortig to pichig because they may be worried about beig caught carryig out the more severe types 1, 2 ad 3. This may be viewed as a alterative method or families may also wrogly believe that this form of FGM is acceptable because it is the least severe (ad harder to detect by health professioals). Some may ot eve regard it as FGM as o cuttig is ivolved. However, it is importat to highlight the differet practices that fall uder type 4 ad that these are also illegal. Type 4 FGM is ofte give little attetio durig awareess raisig i commuities ad traiig of frotlie professioals. 3.4 Age Whe FGM Performed Of the 16 survivors iterviewed directly, 14 of the survivors had FGM performed o them before puberty betwee the ages of 4 to 10 years before arrivig i the UK. Two survivors (Case Studies 11 ad 16) did ot disclose the age at which it was doe. I fact the lady i Case Study 11 shared the story o behalf of her daughter. Although she did ot disclose her exact age, she cofirmed that her daughter was uder the age of 16. She shared her story aoymously via telephoe because she feared beig reported. For those who wat to cotiue this practice i the UK, it is plausible to assume that it is prepubescet girls that are most at risk of FGM. What is also worryig is that although the age of cuttig has remaied fairly stable i most coutries where FGM is practiced, where chage has occurred, the most commo tred is towards youger ages (UNICEF, 2013). Also the data i Table 1 shows that although i some coutries the practice of FGM has declied because fewer girls uder the age of 19 have had it doe, i other coutries the practice remais strog. For example, FGM is a deeply etreched practice i Somalia with a prevalece rate is over 97% ad i the coutries where the prevalece of FGM is high the most commo age for the FGM procedure is betwee 6 ad 8 years (FORWARD, 2007). Due to the close ties betwee diaspora commuities ad relatives from coutries of origi, this tred (age of cuttig ad strog support for the practice) is likely to be reflected here i Birmigham (ad i the UK more geerally). 19

20 Although prevalece of FGM may be lower i the Yemei commuities of Birmigham reflectig the lower prevalece rate i Yeme (compared with rates i Somalia), it is importat to egage with this commuity ad raise awareess of the health ad legal cosequeces of FGM. Cosiderig some evidece was ucovered about Yemei girls havig had FGM (Case Study 15 - Appedix 1), ad wome of Yemei backgroud presetig with FGM at materity cliics, it is importat to do specific awareess raisig i this commuity i the future ad must ot be overlooked (i favour of the Somali commuity). Give the age of the girls at risk, schools are essetial i safeguardig them from FGM. Although all schools should have FGM awareess raisig workshops, staff ad pupils i primary ad juior schools (as well as early year settigs) should be prioritised; by the time girls reach secodary school, the likelihood is that FGM has already bee carried out. However, from our experiece at MWNUK, it has bee very difficult ad almost impossible at times to get ito schools due to the sesitivity of the issue. Due to the publicity about FGM i the media, MWNUK have foud that secodary schools are ow more receptive to workshops ad we have bee workig i partership with FORWARD (through a Departmet of Educatio Grat) to deliver workshops i secodary schools. However, delivery i primary ad juior schools remais a substatial gap i Birmigham as well as i other cities i the UK where FGM practisig commuities have settled i sigificat umbers. To get schools to be more receptive to tacklig this issue, school goverors ad head teachers eed to be targeted for traiig first o this issue ad give assuraces that the workshops ca be delivered usig age appropriate ad sesitive laguage so as ot to stigmatise commuities. 20 Female Geital Mutilatio - Affected Commuities i Birmigham

21 Muslim Wome s Network UK 3.5 Evidece of Girls Udergoig FGM Durig outreach i schools, we have ucovered some evidece that there are girls attedig school that have had FGM. For example, i oe school a 13-year-old girl of Somali backgroud disclosed that she had FGM before arrivig ad settlig i the UK. Aother girl of Yemei backgroud had FGM before arrivig i the UK. Although o legal offeces had bee committed because the girls had FGM before arrivig i the UK, these cases highlight that girls are attedig schools who have had FGM ad are ot receivig ay support. Spottig the sigs ad awareess raisig should ot just be focussed o obtaiig disclosures for the purposes of a prosecutio but also to provide medical ad psychological support too. To date we have ot had ay disclosures from girls who have had FGM while beig residet i the UK. This is ot surprisig because childre will ot wat to get their parets ito trouble. However, our research revealed some evidece to suggest that girls have had FGM while livig i the UK (whether they have had it carried out here or take abroad for the procedure). Examples of evidece iclude: Oe woma disclosed aoymously (Case Study 11 - Appedix 1) that her daughter had FGM. She was upset because her mother i law had doe it agaist her wishes whe her husbad took their daughter abroad for a holiday. This is ulikely to be a isolated case give the pressures exerted by family members abroad as highlighted by some of the survivors. Oe youg woma (Case Study 8 - Appedix 2) said that although she had ot had FGM, she recalled her mother bribig her ad her sisters to have it doe durig a trip to Dubai. As the appoitmet had to be rescheduled, it was ot carried out ad the girls retured to the UK without havig FGM. This is also ulikely to be a isolated case. Oe 15-year-old girl purposefully did ot wat to liste to the FGM talk i school ad became disegaged. She appeared very upset ad left the room. Oce she calmed dow, she repeatedly asked if FGM was agaist the law ad agaist Islam. From her resposes ad behaviour we suspected she may have had FGM but she did ot disclose, which may have bee due to the fear of gettig family members ito trouble. There were aother couple of occasios whe other girls exhibited similar behaviour but did ot disclose either. I oe survey, a 15-year-old girl revealed that she kew a fried at school who had FGM but would ot disclose further details. I other surveys a few girls would ot aswer whether they had FGM eve though the resposes were aoymised. 21

22 4. Research Fidigs - Cosequeces Of FGM Table 4: Summary of cosequeces that emerged from the research Cosequeces Physical Psychological Sexual Social Severe pai Shock Short Term Bleedig / haemorrhage Fever Uable to walk for days Fear Nightmares Flashbacks Woud opeig up Violece Log Term Mestrual blood retetio Uriatig more frequetly Urie retetio Recurrig ifectios Severe pai due to beig cut ope before the weddig ight Complicatios durig child birth Caesaria Nightmares Flashbacks Depressio Axiety Pai durig sex Lack of sexual pleasure Lack of sexual desire Problems with itimacy Whe periods are prologed ot beig able to pray or fast - resultig i religiosity beig questioed ad accused of makig excuses Embarrassmet whe beig medically examied Marriage breakdow / divorce Domestic Violece 22 Female Geital Mutilatio - Affected Commuities i Birmigham

23 Muslim Wome s Network UK 4.1 Effects o Physical Health The health impact ad the severity varied amogst most of the survivors, which may have depeded o the type of the FGM. The followig short-term physical impacts were reported: severe pai, bleedig / haemorrhage, fever, uable to walk for days ad the woud opeig up. Examples of log-term effects reported icluded: mestrual blood retetio resultig i prologed periods, uriatig more frequetly, urie retetio, recurrig ifectios, further severe pai due to beig cut ope before the weddig ight, pai durig sex, complicatios durig child birth ad delivery by caesaria. Domestic violece was also reported, which resulted from wome ot watig to have sex because it was too paiful. There are other physical health implicatios of FGM that were ot metioed by the survivors we iterviewed but it does ot mea they were ot sufferig from them. Some of these icluded ifertility ad beig proe to cysts ad keloid formatios, which ca result i uiteded cuts ito the urethra ad rectum that may cause fistulas. It ca be hypothesised that the health cosequeces related to FGM will become more severe if wome ad girls do ot ask for help or whe they do, do t idicate the uderlyig reasos for their problems. Youg girls (ad their parets) may be reluctat to ask for help due to the fear of gettig ito trouble with the law. Eve where girls have already bee cut before settlig i the UK ad o legal offece has bee committed, they may still ot ask for help due to the fear of beig stigmatised ad beig scrutiised with regards to other girls i the family. From 31 October 2015 frotlie practitioers such as those workig i the health care service have statutory duty to report kow FGM for uder 18 year olds. These ew rules will make it harder for childre ad their parets to ask for help over health cocers. It is therefore vital that doctors ad urses are traied to be vigilat i idetifyig medical problems that may be liked to FGM, idetifyig risk of FGM ad speakig with patiets sesitively. Some good practice is listed below (British Medical Associatio, 2011): Good Practices For Health Professioals Esure that care is take ot to make affected girls ad wome feel stigmatised - for example ot usig the term female geital mutilatio as it may be cosidered offesive or iappropriate ad tryig istead to use eutral terms such as female geital cuttig (or eve circumcisio). Address cocers sesitively so as ot to exhibit sigs of shock, horror or revulsio. Cosider other girls ad wome i the family who may be at risk of FGM or sufferig from the cosequeces of it whe dealig with particular cases. Whe takig routie patiet history from girls ad wome from commuities that practice FGM, ask about FGM e.g. this could be doe whe registerig ew patiets. Whe vacciatios are requested for overseas trips to coutries of origi that practice FGM, cosider risk of FGM ad ask questios ad raise awareess about the law ad health cosequeces. Medical professioals such as doctors are ofte viewed as authority figures ad highly respected ad therefore could also play a importat role i efforts to support commuities to abado FGM by raisig awareess of its harmful effects ad health risks by speakig at commuity evets ad to ifluecers i the commuity such as religious leaders. 23

24 4.2 Psychological Effects From the accouts give by the survivors, it was clear that the cuttig was a traumatic experiece for most of them ad the psychological impact had lasted ito adulthood. May cotiued to have ightmares ad flashbacks, which are likely to be udiagosed symptoms of posttraumatic stress. Some examples of experieces are: Survivor still gets frighteed thikig about the experiece ad gets ervous whe she sees sharp tool or blade. (Case Study 4 - Appedix 1) Survivor says she caot forgot what happeed ad keeps havig ightmares about the cuttig ad eve thought she could see the cutter whe she was givig birth. (Case Study 5 - Appedix 1) Survivor remembers what happeed i the bush every time she has fever. (Case Study 6 - Appedix 1) Memories are triggered ow by the smell of Dettol. (Case Study 9 - Appedix 1) Whe the survivor sees her husbad s razor, it remids her of that time. (Case Study 14 - Appedix 1) It also appears that most have bee sufferig i silece because they have ot shared their trauma with others let aloe receive a therapeutic itervetio for it. For some talkig to the researcher was the first time they had shared their experieces ad feeligs i detail (e.g. Case Studies 1 ad 14 - Appedix 1). Others foud it difficult to talk about FGM ad its impact. For example oe survivor said it was embarrassig to talk about itimate matters ad that wome do t talk about these thigs (Case Study 1 - Appedix 1). As most wome are ot tellig ayoe about their symptoms or speakig about their experieces, they are ot receivig ay cousellig which could help them deal with their axiety, depressio ad post-traumatic stress. Although oe woma did go to her doctor for her axiety, she says that the doctor did ot attempt to ask her about her childhood or uderlyig reasos for her feeligs ad recommeded exercise ad goig for walks. The survivor said she had ot metioed the cuttig either (Case Study 6 - Appedix 1). GPs are ow receivig traiig o FGM from a safeguardig poit of view so they ca better protect childre. However, they also eed to be made aware (particularly those situated i commuities where sigificat umbers are from coutries with high FGM prevalece rates) that some of their cliets may be adult survivors of FGM ad sufferig from metal health issues because of it. They also eed to be able to idetify health problems that may be associated with FGM ad be able to ask appropriate questios so wome feel they are able to disclose ad be referred for cousellig. Cousellig is ot oly essetial for wome to improve their metal health, but ca also help play a crucial part i elimiatig the practice of FGM. Oly whe wome are able to deal with ad process the ager, resetmet ad feeligs of loss ad betrayal by their parets, will they fully uderstad what happeed ad why it happeed. This i tur ca give them the cofidece to challege the practice so others do ot have to go through what they have edured. 24 Female Geital Mutilatio - Affected Commuities i Birmigham

25 Muslim Wome s Network UK 4.3 Sexual ad Relatioship Effects Metal health of survivors ca deteriorate further if the FGM has resulted i relatioship problems ad domestic violece icludig breakdow of marriages. Examples of experieces provided by survivors iclude: Oe survivor explaied that sex with her husbad is very paiful ad was beate at the begiig of her marriage but says her husbad is more uderstadig ow. (Case Study 1 - Appedix 1) Oe survivor ackowledges the difficulty it causes i her marriage because she does ot wat to have sex. (Case Study 3 - Appedix 1) Oe survivor says sex cotiues to be paiful ad she does ot ejoy it ad makes excuses ot to have sex which has caused difficulties i her marriage (Case Study 4 - Appedix 1) Oe survivor says sex is so paiful that she has to sit i cold water afterwards ad also makes excuses to avoid sex which has led to domestic violece, which is just accepted as a way of life by wome. (Case Study 7 - Appedix 1) Whe oe survivor refused to have sex with her husbad (due to the pai), she was told she was ot a good woma ad felt pressured to have sex eve though she does ot wat to. (Case Study 12 - Appedix 1) Oe survivor explais that the impact of the FGM has resulted i her havig o feeligs towards her husbad. (Case Study 14 - Appedix 1) Oe survivor idicated that she was ot too active sexually because she did ot feel aythig ad it was causig problems. (Case Study 16 - Appedix 1) Sexual difficulties are therefore causig sigificat amouts of stress i wome s lives because they are havig sex eve though they do ot wat to because of the pai. This is likely to make them feel iferior because they are merely the meas of the husbad s gratificatio. It is therefore also importat to raise awareess of such cosequeces of FGM to me. This could help shift their attitudes so they are agaist the practice as they would realise the impact o me. 25

26 4.4 Social Effects Wome who have ot had FGM or who are ot willig to subject their daughters to it could also be psychologically affected because they are stigmatised by other family ad commuity members ad deemed uclea or umarriageable. This ca lead to isolatio ad beig excluded from the commuity. This ca result i pressure to coform that eeds to be resisted. For example oe participat of Gambia backgroud (Case Study 2 - Appedix 2) who had ot had FGM said she was ostracised ad bullied as a child: I remember the bullyig itesified whe oe of the girl s stood outside the toilet ad had probably heard that I was t tricklig but was gushig. Whe I came out she told me I was uclea ad impure ad she wet ad told the other girls ad they stopped hagig aroud with me. She wet o to explai how she wished she had FGM because she felt so isolated. She also felt the same whe her marriage broke dow because her husbad accused her of sleepig aroud because she was ucut. Wome ad girls i the UK ca also face similar type of bullyig or pressure. I aother example, a 23-year-old woma of Somali backgroud (Case Study 6 - Appedix 2) who had ot had FGM said she felt left out whe she was growig up. She said she would feel left out whe her older sisters (who had FGM) used to talk about it ad felt eve more left out whe she became aware that her frieds at school had bee cut too: I thought I was missig out ad really wated to have it doe ad kept askig my mum to let me get it doe. However, she said she was put off the idea whe she foud out about the health problems her sisters faced, which was reiforced by a TV documetary o FGM. Aother Somali youg lady aged 17 (Case Study 7 - Appedix 2) explaied how her cousis pressured her durig a trip to Somali. She was aroud 14 years old at the time whe they were tryig to persuade her to agree to havig FGM. She said she that although she maaged to resist the pressure, it was difficult. Oe survivor explaied how she made others feel iferior to her because they had ot bee cut (Case Study 9 - Appedix 1): I used to walk i proud makig them feel less tha me. It was me suppressig my feeligs ad showig that I ve bee brave ad cut properly whilst they have bee piched ad still remai uclea. I thought they were lower class tha me; I was proud that I was able to go through the worst type of cuttig. Aother survivor, who has ot had her daughter cut, is beig stigmatized by her ow commuity (Case Study 12 - Appedix 1): Both my eighbours are Somali ad they wo t let their childre play with my daughter because she is ot circumcised eve though oe of the girls is her best fried at school. Little attetio has bee give to the psychological eeds of wome ad girls who have ot bee cut. It is therefore importat to esure that culturally sesitive psychological itervetios are also made available to them. Cousellig ca have a dramatic impact o the metal well beig of wome ad girls, which i tur ca lead to icreased cofidece to resist ad challege a deeply igraied cultural traditio. This kid of support is essetial give that they are from a culture where it is importat to be dutiful to parets ad hold elders i high regard; tellig them that FGM amouts to child abuse ad resistig their demads will ot be easy. At the time of writig this report, there are curretly o FGM metal health specialist services i Birmigham, which is a sigificat gap i services cosiderig the size of the local FGM affected commuities. For cousellig to be most beeficial, the cousellors should ot oly be traied o the issue of FGM but wome from FGM affected commuities (who do ot ecessarily have to have udergoe FGM themselves) should also be traied as they will be able to better facilitate coversatios durig cosultatios ad able to respod ad ask questios i a o judgmetal maer / more appropriately. 26 Female Geital Mutilatio - Affected Commuities i Birmigham

27 Muslim Wome s Network UK 5. Research Fidigs - Reasos for FGM Faith was cited as oe of the reasos for the practice of FGM. However, this is discussed i Chapter 6. Other key reasos provided for FGM were liked to trasitio ito adulthood, clealiess, maitaiig chastity ad for pleasure of husbads (ad therefore esurig she is marriageable). The participats highlighted these as follows: The survivor was told she would be clea ad would o loger be a girl ad would be like everybody else ad ot be left behid. She was also made to believe that it is shameful to live with the geital area ope. (Case Study 1 - Appedix 1) The cuttig also ivolved beig iitiated to be part of a society to take care of husbads. (Case Study 4 - Appedix 1) Afterwards the survivor was told that she was clea ad perfect ad a good girl ow. (Case Study 5 - Appedix 1) The survivor believed it was a rite of passage from childhood to womahood. (Case Study 6 - Appedix 1) The survivor said it has to be doe for a girl to be moral ad was told that it is doe for clealiess, religio ad because that is what husbads wat for marriage. (Case Study 8 - Appedix 1) The survivor was told that she was goig to become a woma ad was told it was goig to remove dirt, make her clea ad so she ca become a real Muslim. (Case Study 10 - Appedix 1) These are deeply rooted beliefs as highlighted by this statemet: My mother believed it was a rule that must be adhered to regardless of the cosequeces (Case Study 1 - Appedix 1). Some of the other survivors said FGM was doe because it was a traditio. Due to such deeply held beliefs to justify FGM there will be parets i the UK who will be subjectig their daughters to FGM eve though it is agaist the law. However, there will also be parets whose childre may be beig subjected to FGM without their kowledge or permissio as i (Case Study 11 - Appedix 1). The mother disclosed that the father took the daughter to Gambia where exteded family members arraged for her to be cut. The mother was very upset about what her daughter was made to go through but very frighteed to tell ayoe due to the fear of gettig ito trouble. It is importat that there are mechaisms for mothers like the oe i this Case Study to be able to come forward ad esure the child receives the help that is eeded without beig prosecuted. I fact, durig commuity educatioal raisig campaigs it is importat to reach out to mothers ad fathers who may be i similar situatios who do ot wat their daughters cut ad ecourage them to report cocers so that they ca be supported ad their daughters protected from beig cut. 27

28 6. Research Fidigs - Role of Religio 6.1 Is FGM Cosidered Islamic? Durig the research we also attempted to fid out the role of religio i perpetuatig but also challegig the practice of FGM. As all the oe to oe iterviews were coducted with people who idetified as Muslim, we have oly focussed o the role of Islam. Although FGM is ot sactioed by ay faith icludig Islam, it does play a role i preservig the practice. Some of the wome iterviewed erroeously believed or were told that it was a religious obligatio ad eve used the word Suah (Prophet Muhammad s pbuh practices) to describe FGM: Survivor was told by her mother that it was a Islamic traditio ad God would be pleased with her ad speakig agaist it would result i evil agaist her. (Case Study 1 - Appedix 1) Survivor was give a umber of reasos for beig cut which icluded religio. (Case Study 8 - Appedix 1) Survivor had believed it could be justified o religious grouds ad was willig to do it to her daughters util she foud out it was a cultural traditio. (Case Study 9 - Appedix 1) Survivor was told she was goig to be cut so she could become a real Muslim. (Case Study 10 - Appedix 1) Oe woma of Idoesia heritage who had ot bee cut, said that girls are beig made to have FGM i coservative areas i Idoesia because it was cosidered a religious obligatio. (Case Study 4 - Appedix 2) Clealiess ad hygiee was also metioed ofte as a reaso for FGM, which is likely to be coected to religio because Islam places great emphasis o both physical ad spiritual, clealiess ad purificatio. The other wome uderstood that FGM was ot a religious obligatio but was doe as a cultural traditio particularly associated with the trasitio to womahood, prevetig promiscuity ad beig marriageable. Despite deliverig presetatios schools highlightig that the practice is agaist all faiths, some girls did ot appear coviced judgig from their reactios ad commets made i the questioaires. 28 Female Geital Mutilatio - Affected Commuities i Birmigham

29 Muslim Wome s Network UK Iterestigly of the six me iterviewed, five said the practice was agaist Islam: Somali male said it was beig doe i ame of traditio ot Islam. (Iterview 1 - Appedix 4) Sudaese male said he was agaist the cuttig ad it was agaist his religio. (Iterview 2 - Appedix 4) Gambia male said whe his mother made his sisters have FGM, his father, who was a very religious ma, was very upset ad eve threateed to divorce his mother over the cuttig. (Iterview 3 - Appedix 4) Somali male who is also a imam said that cuttig was agaist Islam ad would ot subject his daughter to the practice. (Iterview 4 - Appedix 4) Somali male who was a imam said that FGM was agaist Islam but was referrig to type 3 ad alluded to other types beig acceptable. (Iterview 5 - Appedix 4) It is evidet from these resposes that some people i FGM affected commuities believe that the practice is religiously madated despite the fact that may Muslim theologias have stated it is cotradictory to the teachigs of Islam. This cofusio probably arises from the fact that ot all Muslim faith leaders are cosistet with their messages ad the levels of codematios vary. This was highlighted by oe imam we spoke to who was very strog i his codematio of the most severe form of FGM, type 3 (iterview 5 - Appedix 4). He said this was prohibited i Islam. However, he was reluctat to say that the other types (1, 2 ad 4) were agaist Islam. Aother imam whom we wated to work with to help codem the practice, was willig to do this publicly by sayig that Islam does ot allow harm, but he was reluctat to opely challege the secodary religious texts i.e. hadiths that are sometimes used to provide a religious justificatio for FGM (as highlighted i sectio 6.2). He was cocered about the reactio ad backlash from his commuity. Such mixed messages are resultig i some Muslims believig the practice is a obligatio or at least recommeded by Prophet Muhammad (pbuh) while others believe it is prohibited or optioal. It is therefore clear that if FGM is to be challeged theologically, it is simply ot sufficiet just to state Islam does ot sactio it. More detailed explaatios eed to be provided about why this practice is ot oly agaist the faith but also strogly codemed by it. This message eeds to be delivered particularly by faith leaders from FGM affected commuities, as they are likely to have more credibility tha faith leaders from o-fgm affected commuities. However, faith leaders from o-practicig commuities, who are ofte less aware about the practice of FGM should also be traied o this issue ad be familiar with the theological argumets if they are servig a commuity that also icludes people from FGM affected commuities. The religious texts commoly used to justify FGM ad how these ca be challeged is discussed i the ext two sectios. 29

30 6.2 Religious Texts Used to Justify FGM The source of the problem arises from the followig secodary religious texts kow as hadiths (arratios that have bee attributed to Prophet Muhammad pbuh) that are used to support the practice of FGM. 1. Not to cut wome too severely Narrated Umm Atiyyah al-asariyyah: A woma used to perform circumcisio i Media. The Prophet (peace be upo him) said to her: Do ot cut severely as that is better for a woma ad more desirable for a husbad (Abu Dawud 41:5251). Whe the Prophet (pbuh) saw a woma cuttig, he told her ot to cut too severely - Some scholars will argue that because the Prophet (pbuh) did ot ba the practice, this justifies its permissibility ad / or he was oly prohibitig more severe types of FGM ad acceptig less severe types. They igore the fact that if the words attributed to the Prophet (pbuh) were actually spoke by him, he is makig a statemet that does ot traslate ito a ijuctio for cuttig. However, this arratio has bee widely regarded as weak or poor i autheticity amogst Islamic scholars throughout history because it does ot meet the strict criteria to be cosidered uquestioable. (Rashid, 2014) 2. It is a hoour for wome to be cut Abu al- Malih ib `Usama s father relates that the Prophet said: Circumcisio is a law for me ad a preservatio of hoour for wome (Ahmad Ib Habal 5:75; Abu Dawud, Adab 167). This text is used by some to justify that FGM is a recommeded practice eve it is ot obligatory. However, this arratio is also regarded as weak ad fails the test for beig authetic. Also some scholars iterpret this arratio to mea that whe a woma is married to a circumcised (i.e. ritually clea) ma, it is a hoour for her. It does ot mea that it is a hoour to subject the woma herself to circumcisio. (Asmai & Abdi, 2008: P9) 30 Female Geital Mutilatio - Affected Commuities i Birmigham

31 Muslim Wome s Network UK 3. Whe two circumcised parts meet Muslim (349) arrated that Aa ishah (may Allaah be pleased with her) said: The Messeger of Allaah (peace ad blessigs of Allaah be upo him) said: Whe a ma sits betwee the four parts (arms ad legs of his wife) ad the two circumcised parts (al- khitaaai) meet, the a ritual bath (ghusl) is obligatory. Whe a husbad ad wife are itimate, two circumcised parts (khitaai) meet - the likelihood is that this is used to provide evidece that wome were cut historically to justify cotiuig the practice. Propoets cosider this hadith to be oe of the strogest justificatios for FGM i Islam because this is regarded as authetic. Some scholars say that the two circumcised parts are referrig to that of the husbad ad of the wife, idicatig that wome were circumcised. However, others scholars poit out that the term khitaa i Arabic strictly refers to male circumcisio ad FGM is referred to as khifaadh as explaied earlier. The term khitaaai, though i dual, is ot evidece for FGM because the use of oe word or quality to refer to two differet persos or thigs is a acceptable Arabic laguage style. I this case khitaaai refers to the male ad female orgas but which are differet with respect to circumcisio i.e. male is circumcised, the female is ot. The feature of the more commo or promiet oe i.e. male circumcisio is used. (Asmai ad Abdi, 2008: Page 10) 31

32 6.3 Role of Islam to Challege FGM I sectio 6.2 we have discussed how the religious texts that are commoly used to justify FGM ca be challeged. However, the practice ca also be challeged by usig the followig theological argumets: 1. Challegig Usig the Qura There is o metio of FGM i the Qura ad ot a sigle verse ca be used to justify it although propoets of the practice will argue that there is o evidece to forbid it either. However, there are several verses that ca be used codem the practice. Examples iclude:...ad there is o chagig Allah s creatio (Qura 30:30) You will ot see ay flaw i what the Lord of Mercy creates (67:03) ad make ot your ow hads cotribute to your destructio (Qura 2:195) There is a priciple of do o harm i Islam. For example, the Qura baed the killig of female ifats, a commo practice i pre-islamic Arabia: whe the girl child who was buried alive shall be asked for what si was she killed (Qura: 89: 8-9). It ca be argued that all forms of barbaric acts of violece committed agaist girls ad wome i today s society equates to the moder day versio of buryig girls alive. The propoets of FGM will argue that this does ot apply because male circumcisio is practiced amogst Muslim commuities. However, research shows that circumcisio i me does ot impair their sexual fuctio or satisfactio ad has may well documeted medical beefits (Castlema, 2015) therefore does ot cause harm. O the cotrary, FGM has o medical beefits ad harms physical ad psychological health as well as affectig sexual fuctioig. 32 Female Geital Mutilatio - Affected Commuities i Birmigham

33 Muslim Wome s Network UK 2. Challegig Usig the Suah There is o evidece i ay hadiths to suggest that the Prophet (pbuh) subjected his daughters or his wives to FGM. The daughters ad the wives of his compaios were ot circumcised either. For those who say that the practice is recommeded by the Prophet (pbuh) are overlookig the fact that he would ot recommed or make obligatory somethig he did ot do himself. If the wome i his family were circumcised, it would have bee well kow ad would be widely practiced i all Muslim majority coutries, which it is ot. Watig to curb the sexual desire i girls ad esure they virgis (ad therefore marriageable) is such a deeply rooted cultural traditio that it is prioritised over ad above religious beliefs. Eve though there is overwhelmig evidece that FGM is ot a religious practice ad coflicts with the teachigs of Islam, commuities still cotiue to practice it. They will eve provide erroeous religious justificatios to reiforce its cotiuatio. These liks betwee religio ad FGM therefore caot be igored especially because faith leaders themselves are providig coflictig views o the matter. To eradicate it, religious leaders eed to speak with oe voice uequivocally codemig this harmful practice i all its forms. To achieve this, they must egage with medical experts ad gai a uderstadig about the fuctios of the female geital orgas ad the harmful effect of cuttig (icludig physical, psychological ad sexual). This will eable them to fully uderstad what FGM etails whe they provide advice or ruligs about it. They also eed to take the lead ad ot exhibit double stadards whe it comes to chastity ad morality. Accordig to Islamic teachigs, these are equally applicable to males as well as females. Subjectig FGM to girls is degradig ad disrespectful because they are all regarded as ot beig able to cotrol their sexual desires ad assumptio is beig made about their sexual behaviours. Util this happes, fatwas (religious edicts) codemig the practice will have a limited impact as we have already observed. For example, i 2007, Grad Mufti Ali Gomaa s issued a fatwa codemig FGM which was followed with a statemet by the Azhar Supreme Coucil for Islamic Research (highest religious authority i Egypt) explaiig that FGM has o basis i Islamic law. However, although FGM prevalece has declied from 91% i Egypt, the levels still remai high (UNFPA Egypt). Similarly i the UK, religious ad commuity leaders have uited to sig a joit declaratio codemig the practice ad statig it is ot supported by ay religious doctrie (Gov.uk). However, its very impact will be limited if religious leaders withi FGM affected commuities are ot all equally codemig the practice (i all its form) or ot willig to do it publicly as highlighted by this research. 33

34 7. Research Fidigs - Social Attitudes To eradicate the practice of FGM a major attitudial chage is a required. Durig the research we explored whether there was ay support for edig the practice, whether people were willig to traslate this support ito actio ad what the barriers were to chagig midsets. 7.1 Attitudes of Wome The survivor accouts revealed the highly stigmatised ad egative attitudes held agaist girls ad wome who do ot have FGM, which seemed to be drivig the cuttig. They were regarded as uclea ad umarriageable (see chapter 5). There was evidece of ostracisatio ad bullyig of girls ad their families, which could result i families succumbig to pressure ad eve girls themselves watig it doe. Case Study 12 (Appedix 1) Both my eighbours are Somali ad they do t let their childre play with my daughter because she is ot circumcised eve though oe of the girls is her best fried at school. Case Study 2 (Appedix 2) I remember the bullyig itesified whe oe of the girls stood outside the toilet ad had probably heard that I was t tricklig but was gushig. Whe I came out she told me I was uclea ad impure ad she wet ad told the other girls ad they stopped hagig aroud with us. Case Study 6 (Appedix 2) I thought I was missig out ad really wated to have it doe ad kept askig my mum to let me get it doe. The wome iterviewed who had ot bee cut usurprisigly did ot favour maitaiig the practice. Half of the wome who had bee cut were also strogly agaist the practice ad wated it to ed. The other half remaied silet o the issue, which did ot ecessarily idicate they supported it. Some may have felt ucomfortable opely criticisig a traditio that was a part of their culture to a iterviewer who was from outside of their commuity. Others may be agaist the practice but ot strog eough to go agaist social orms. 34 These attitudes may ot ecessarily reflect the wider commuity due to the small sample of wome iterviewed ad the fact that those that agreed to be iterviewed may have doe so because they do ot support the practice. However, the fact that these wome do ot wat to cotiue the practice ad those who have daughters have ot carried FGM o them is a positive sig. This idicates there is at least some willigess to go agaist commuity orms Female Geital Mutilatio - Affected Commuities i Birmigham

35 Muslim Wome s Network UK ad resist pressure to ed the practice. Some were eve willig to report cocers to the police but most others preferred ad felt more comfortable cotactig a volutary orgaisatio such as a wome s group. Case Studies of Survivors from Appedix 1 Survivor said she would ot allow her daughters to go through it ad would ot be takig them back to Somalia (Case Study 1) If she was cocered about a girl i the commuity she would cotact the school or a wome s orgaisatio (Case Study 2) She was willig to cotact professioals ad eve go to the police if she felt a girl was at risk (Case Study 3) Would be willig to call the police if a girl was at risk (Case Study 5) She is brigig her sos ad daughters up to challege the traditio of FGM (Case Study 12) She would ot do that to her daughter if she had oe (Case Study 13) She said she would ever put her daughters through FGM (Case Study 14) A couple of the survivors eve wated physical examiatio of girls up to them becomig teeagers (Case Studies 3 ad 5 - Appedix 1) poitig out that Frace do more checks. Oe of them said that whe her daughter was bor the health visitor did explai to her the reasos for ot gettig FGM doe. However, she said that o oe checked up o her daughter agai ad poited out that she could have easily take her abroad for FGM ad o oe would have kow. It is importat to utilise wome who are breakig the cycle of FGM (by ot subjectig their daughters to it). Activities should be idetified where their support ca be utilised i public campaigs so they ca share their stories ad views. Some may ot wish to be idetified due to the backlash they may face from others i their commuities ad should be supported i sharig their stories aoymously. Wome who have ot bee cut could also be recruited for public campaigs to highlight that despite ot beig cut, they have got married. Oe survivor was willig to provide such support but aoymously. MWNUK therefore utilised this opportuity ad filmed a iterview with her without revealig her idetity for a campaig video. Eve with the support of these voices, eradicatig FGM will be challegig because the mai istigators of the practice are other wome. Despite the traumatic experieces of FGM some wome will be made to feel guilty ad will be tor betwee the welfare of their child ad societal pressures. They will also worry that by ot havig FGM, the matrimoial opportuities for their daughters will dimiish. This area eeds attetio. The cofidece of wome eeds to be built up so they are more resiliet to pressure from family ad other commuity members. For example, they could be helped to vocalise their views sesitively but with robust couter argumets. However, the first step eeds to be to ecourage wome to have coversatios about FGM amogst themselves. Whe beig iterviewed most survivors said it was ot a issue that is discussed amogst frieds because they feel very ucomfortable talkig about such persoal matters. A few eve said the research iterview was the first time they had spoke i such detail about their experieces, cosequeces ad feeligs. 35

36 7.2 Attitudes of Me We were able to iterview 6 me for the study who were betwee 33 ad 58 years old, who were of Somali, Sudaese ad Gambia backgrouds (see Appedix 4). Their iterviews revealed that it was usually a issue ot discussed amogst the me, it was regarded as a wome s issue because accordig to them the mai istigators were the wome. Somali Male (Iterview 4 - Appedix 4) I my family my sisters have had it doe ad my wife has had the cuttig, but I have t had a coversatio about it. The research did show that wome did ot ivolve them i the decisio-makig. There was evidece that some couples did ot eve discuss the issue eve amogst themselves leadig to discord amogst couples. The survivors gave examples of their mothers hidig the cuttig from their fathers because they opposed the practice (see Chapter 3 o the Primary Istigators). Ay educatioal campaigs should therefore ecourage ope dialogue betwee husbads ad wives. Gambia Male (Iterview 3 - Appedix 4) Me have the iformatio hidde from them. My father was really upset whe my sister had it doe. He was a religious ma ad really agaist it ad threateed to divorce my mother if she did it agai to ay of the other daughters. Me who were married said that they were agaist it after witessig the cosequeces with their wives. Those who were ot married were also agaist FGM idicatig that they would ot marry someoe that was cut. Oe male said whe he was ready to get married he requested for a woma that was ot cut. The lik betwee FGM ad sexual / relatioship problems was also evidet i our research ad it is also importat to raise awareess of these. Paiful sexual itercourse ad ot watig to have a physical relatioship with their husbads was highlighted by may of the survivors. This issue was also highlighted by oe of the imams iterviewed. He said: I kow that may of the couples that come to me for issues such as domestic violece that result from bedroom issues, ad most probably we have to ask the questio why is this? Somali Male (Iterview 1 - Appedix 4) If she does ot have ay feeligs the what s the poit? I do t ever wat to marry ayoe from our commuity. Somali Male (Iterview 5 - Appedix 4) I asked for someoe who was ot cut ad equally will make sure my daughters are ot cut. Somali Male (Iterview 6 - Appedix 4) There is o poit i gettig married to someoe who has had it doe, what pleasure do they feel if this is take away from them. 36 Female Geital Mutilatio - Affected Commuities i Birmigham

37 Muslim Wome s Network UK There was also evidece that whe me were ivolved i decidig o whether their daughters should udergo FGM, they were ot cut. This is evidece that me ca play a importat role i decisio-makig that ca evetually result i the practice beig abadoed. Somali Woma (Case Study 1 - Appedix 2) She said she was ot cut because of her father Somali Woma (Case Study 3 - Appedix 2) She has ot had FGM ad puts is dow to her father but thiks that her mother did ot share his views: My dad told me it is haram (ulawful i Islam) ad it s completely agaist our religio, however, my mother o the other had has stayed quiet. Gambia Male (Iterview 3 - Appedix 4) Although his wife has had FGM, he has five daughters ad they have ot bee cut because he ad his wife do ot believe i it. This suggests that discussios o edig FGM should ot just ivolve wome but also me icludig ifluecers such as faith leaders. Me ca be importat agets of chage but seem to be curretly uder utilised i the UK. It is importat that iformatio campaig aimed at girls ad wome should also highlight that some me ad boys are agaist FGM, especially highlightig that some are refusig to marry cut wome because it affects the sexual relatioship. This is importat to highlight give oe reaso used to justify FGM is because it icreases the ma s sexual pleasure. This may also result i more support to ed the practice. Durig the research MWNUK idetified me ad boys willig to speak out agaist FGM. For example, oe Yemei male member of staff at St. Albas Academy wrote a Arabic / Eglish poem agaist FGM, which was recited by a Yemei male school pupil at a FGM evet. MWNUK were able to record this recitatio for a campaig video. 37

38 7.3 Attitudes of Boys Whe tryig to fid out to views of boys we held workshops i a mixed school. Whe the boys ad girls were together i the class, both geders were ot willig to express their views. We the decided to speak to them separately. Five sessios were held for the boys aged 13 to 16 years old, each icludig approximately 24 boys. However, they were from diverse backgrouds. Approximately oe third i each sessio were from FGM affected commuities. This meas that of the 120 boys, approximately 40 were from FGM affected commuities (the vast majority of who were from a Somali backgroud). Most of the boys from the FGM affected commuities seemed to be uaware of what FGM was ad seemed horrified whe they foud out ad seemed surprised that girls livig i the UK were beig subjected to it. This is perhaps ot surprisig because it had already emerged through the iterviews from adult me ad wome that me did ot seem very ivolved i the issue. However, a small umber of boys who were ew migrats ad perhaps oly bee i the UK for about 2 years held coservative views o the issue. They wated to hold o to their culture ad said that they should ot be chagig the traditio of their forefathers. They felt that edig the practice was a Wester otio ad that the West were puttig a egative spi o FGM. They wet as far as sayig that it was good for girls to go through it. Oe was so vocal that he left the sessio by mutual agreemet ad was spoke to later by school staff. Such views idicate the importace of workig with ew migrat commuities ad ot just with well established ad settled commuities. 38 Female Geital Mutilatio - Affected Commuities i Birmigham

39 Muslim Wome s Network UK 7.4 Attitudes of Girls Whe tryig to fid out to views of girls we held workshops i two girls schools (icludig oe Islamic school) ad oe mixed school. After a awareess raisig sessio questioaires were haded out to be filled i aoymously to fid out more about their views. Not all girls filled them i. We delivered workshops to 560 girls aged 11 to 16 years old. We separated out the questioaires of the girls from FGM affected commuities, which totalled 77. Most girls (79%) were Somali ad the remaider were of Yemei, Egyptia, Cogolese, Gambia, Nigeria, Sierra Leoea ad Zimbabwea backgrouds. The vast majority were of the Muslim faith (91%) ad 9% were Christia. Oly 13% of the girls were bor i the UK with most beig bor outside of the UK icludig coutries of origi such as Somalia, Gambia, ad Nigeria or i aother Europea coutry such as Hollad, Demark, Filad ad Norway. However, a large umber were bor either i Somalia or Hollad. It was oted that a few were more recet migrats ad had oly bee i the UK for about 2 years. The resposes to the questioaires ad also reactio of a few of the girls did idicate that some had udergoe FGM. For example, 10% preferred ot to say if they kew ayoe who had FGM. I fact 3 girls did admit to kowig of girls who had FGM. However, they did ot say where this had bee carried out (i.e. i the UK or abroad) ad whether it was doe before settlig i the UK. Whe asked whether they had FGM, most said they had ot but 3 girls chose the optio prefer ot to aswer. Oe girl said that a fried had admitted to havig FGM ad was boastig about it but as soo as she foud out the other girls had ot had it doe, she stopped talkig about it. This icidet perhaps highlights that some girls may ot see it as a abuse but somethig that is hoourable. It is importat that such attitudes are take ito accout ad sesitively challeged whe deliverig workshops to girls because there may be girls preset who associate FGM with positive messages such as gettig pampered with ew clothes, presets, sigig, dacig ad that the cuttig is about becomig clea, a celebratio ad a trasitio to adulthood. If havig FGM is associated with positive messages ad ot havig FGM results i beig stigmatised, the girls are likely to feel pressurised ito watig FGM. For example, oe 23 year old iterviewee who has ot had FGM (Case Study 6 - Appedix 2) said that whe she was at school (i the UK) ad foud out that her frieds were cut, she also wated it doe: I thought I was missig out ad really wated to have it doe ad kept askig my mum to let me get doe. Now she says she feels lucky she did ot have FGM. It is therefore importat to fid ways to make girls more resiliet to peer pressure ad ot just give them the iformatio but to also better equip them with the skills to couter the argumets that will be used to justify FGM. It was oticed that three girls (aged years old) durig the sessios seemed completely disegaged from the workshop. They did ot appear to be listeig to the workshop or eve lookig at the speaker or the presetatio. Oe eve covered her ears with her hads ad became very distressed. She evetually left the classroom. Outside of the classroom she repeatedly asked about the Islamic positio o the issue ad had to be costatly reassured it was ot a part of ay faith. She also wated to kow what the law said ad the setecig associated with FGM. This was explaied to her. Although she did ot admit to havig FGM, the teacher ad head teacher were iformed for follow up coversatios ad support with her. These icidets highlight that girls will be reluctat to disclose FGM if they have had it due to the fear of the cosequeces of gettig their family, especially parets, ito trouble. 39

40 There was also reluctace amogst girls to disclose cocers about FGM because 20% said they were usure if they would tell ayoe if they or a fried were at risk. Some idicated that they felt ucomfortable about breachig a fried s cofidetiality. However, it was ecouragig that most would be willig to tell someoe if they or especially a fried was at risk because they uderstood the cosequeces of FGM as highlighted by some of their commets: I would tell someoe as my fried would be riskig her life. I would ot wat to see my fried suffer. I would ot wat my fried to go through the pai. I would wat to save my fried. It is therefore importat to esure girls uderstad the importat role they ca play i helpig safeguard their frieds especially because girls at risk of FGM are most likely to tell someoe i their peer groups i preferece to a professioal such as a teacher, school urse or police etc. or cotactig a helplie or third sector orgaisatio (see figure 2 below). Figure 2 Who girls would disclose or report cocers of FGM to 32 / / / / / / / / / 77 42% Fried 36% Third sector - wome s group 35% GP / doctor 32.5% Health worker 23% School teacher 22% School urse 21% Midwife 19.5% Police 19.5% Other - majority (87%) of which said family e.g. parets / sibligs - however, these are prepetrators. 40 Female Geital Mutilatio - Affected Commuities i Birmigham

41 Muslim Wome s Network UK Durig the workshops, oe 13-year-old girl did disclose that she had udergoe FGM (see Case Study below). However, it had bee doe before arrivig i the UK whe she was oly 6 years old. The school safeguardig lead ad the local Multi Agecy Safeguardig Hub (MASH) were iformed so she could be provided with support such as cousellig. Case Study - Disclosure of 13 year Girl at School I was about 6 years old whe I was take to a house where wome surrouded me. They lay me dow ad pulled my trousers dow ad oe started cuttig me with a blade. Whe I started screamig oe of the wome covered my mouth with a cloth. I foud it difficult to breathe. Every time I screamed the cloth was put back over my mouth. My mother was uaware because her fried had take me to this house to get me doe. My dad did ot kow what happeed ad still does ot kow. The images of what happeed still come back to me about 2 or 3 times a week. Sometimes I start screamig. I get very agry ad upset whe I thik about what was doe to me. Sometimes I just stop talkig to everyoe aroud me ad I calm myself dow. I have tried talkig to my mum but I fid it hard ad do t feel comfortable talkig about my feeligs. I wat to get help about my feeligs i school but I do t wat my parets to kow. This case highlights that there will be girls who are livig with the cosequeces of FGM which they have had prior to arrivig i the UK but are ot receivig the medical ad therapeutic help that they eed. Girls like this may ot be disclosig as they are worried about gettig their families ito trouble ad therefore missig out o vital support. More eeds to be doe to ecourage such girls ad their families to disclose so they ca start receivig the right help as early as possilbe. 41

42 8. Coclusio ad Recommedatios 8.1 Coclusio This research has highlighted: experieces of wome who have udergoe FGM, why some wome did ot have FGM; male ad youth attitudes; the procedure of FGM ad its cosequeces; why the practice is carried out; who are the mai istigators; ad the role of religio. I doig so we have bee able to share importat isights that could help to evetually ed the practice of FGM. From the research we were uable to determie whether FGM was beig specifically performed i Birmigham but there was some evidece that it is takig place i the UK. However, wome ad girls i Birmigham are livig with FGM but ot comig forward ad askig for help (uless they are idetified by health professioals). There are wome ad girls who had their FGM prior to arrivig ad settlig i the UK, which meas they have ot broke the law. However, it appears they are reluctat to ask for help due to the perceptio that they may get ito trouble, stigmatised or viewed with suspicio (especially wome who have daughters). It is importat more is doe to ecourage such wome ad girls to come forward. For example, oe 13-year-old girl oly disclosed her FGM because of a school workshop. She is ow receivig much eeded help to deal with her flashbacks ad trauma. However, it is ulikely the girl is receivig specific culturally sesitive cousellig. This is a major gap i Birmigham that eeds addressig give the sigificat size of FGM affected commuities ad the umbers of wome idetified as havig FGM durig materity cliics. Cousellig is ot oly essetial to improve metal health, but ca also help play a crucial part i stoppig the practice of FGM. Oly whe wome are able to deal with ad process the ager, resetmet ad feeligs of loss ad betrayal by their parets, will they fully uderstad what happeed ad why it happeed. This i tur ca give them the cofidece to challege the practice so others (especially their daughters) do ot have to go through what they have edured. Health professioal eed to be traied to be more vigilat at idetifyig medical problems that may be liked to FGM ad ot just focusig o idetifyig risk of FGM. This will help more girls ad wome to get the medical ad psychological support they eed. They are also more likely to disclose if doctors ad urses use sesitive laguage ad ask the right questios. As medical professioals such as doctors are usually highly respected i these commuities, they ca play also a importat role i helpig commuities to abado FGM. They ca raise awareess of its harmful effects ad health risks by speakig at commuity evets ad by speakig to ifluecers i the commuity such as religious leaders. Due to such deeply held religious or cultural beliefs that are used to justify FGM there will be parets who will be subjectig their daughters to FGM eve though it is agaist the law. To prevet detectio some may be optig for a medicalised procedure either i the UK or abroad (such as the Middle East) or choosig the less severe type 4 FGM (which also may ot be viewed as FGM or agaist the law). There was evidece of this durig the research ad these treds eed to be addressed. 42 Female Geital Mutilatio - Affected Commuities i Birmigham

43 Muslim Wome s Network UK However, there was also evidece that some wome ad me are willig to go agaist social orms ad break the cycle by ot subjectig their daughters to FGM. Some survivors do ot wat to put their daughters though the trauma ad cosequeces of FGM they have experieced. The accouts of the survivors we spoke to were powerful. It is importat that such survivors are ecouraged to speak to other wome i their commuities ad youg girls. If iformatio is received directly from survivors, it is more likely to have a greater impact tha iformatio received from outreach workers or from professioals such as from health or police. Differet ways eed to be idetified to ulock the voice of survivors. However, most of the survivors we spoke to were origially from Africa coutries, with half beig from Somalia. We struggled to obtai oe to oe iterviews with wome from the Yemei commuity. Outreach ito Yemei commuities remais a gap icludig for awareess raisig campaigs, which eeds to be addressed. Highly stigmatised ad egative attitudes towards girls ad wome who do ot have FGM (which is ofte drivig the cuttig) is likely to result i ostracisatio ad pressure to coform. It is therefore essetial to build the cofidece of people who are agaist FGM so they are more resiliet to such pressures. This meas ot just givig them the iformatio but to also better equip them with the skills to couter the argumets that are commoly used to justify FGM. Such traiig should be targeted particularly at wome ad girls because they are most likely to face the pressure, as the mai istigators of the practice are other wome. Despite traumatic experieces of FGM some wome will be made to feel guilty ad therefore be tor betwee the welfare of their child ad societal pressures. They will also worry that by ot havig FGM, the matrimoial opportuities for their daughters will dimiish. However, there is a idicatio that attitudes are slowly chagig because some me, wome ad childre i FGM affected commuities are willig to report cocers of girls at risk to wome s groups ad the police. As girls were more likely to tell a fried, it is importat to emphasise to childre the importat role they ca play i safeguardig. As some me are agaist FGM they ca be very importat agets of chage. Some me ad boys who are aware of the cosequeces of FGM (particularly o the sexual relatioships) do t eve wat to marry wome who have had the procedure. Such views eed to be highlighted to wome because oe reaso commoly stated by those who support the practice is that it icreases chaces of marriage because it is somethig that the me wat. However, male voices are curretly uder utilised i Birmigham ad the rest of the UK. Male religious leaders ca also play a importat role i edig FGM. It is evidet from these research that some people i FGM affected commuities believe that the practice is religiously madated despite the fact that may Muslim theologias have stated it is cotradictory to the teachigs of Islam. FGM has to therefore be also challeged theologically. It is simply ot sufficiet just to state Islam does ot sactio it, which is what happes i most educatioal campaigs ad workshops. More detailed explaatios (usig religious texts) eed to be provided about why this practice is ot oly agaist the faith but also strogly codemed by it. 43

44 8.2 Recommedatios Although recommedatios have bee made throughout the report, a summary is listed below. These measures collectively ca support abadomet of FGM i Birmigham ad the UK ad hopefully stop FGM from perpetuatig dow the geeratios. Commuity Campaigs Recommedatio 1 (Yemei Commuity) Targetted awareess raisig i the Yemei commuity through a outreach worker from that commuity. Recommedatio 2 (Support Groups) More space eeds to be provided for me ad wome to discuss the practice of FGM ad coect those who are opposed to the practice to each other, icludig settig up of survivor groups. Recommedatio 3 (Buildig Resiliece Agaist Peer Pressure) Give cofidece to me, wome ad childre to resist peer pressure. This meas ot just providig iformatio o FGM but also developig skills to couter the argumets used to justify the practice. A importat elemet should iclude breakig the lik betwee the status of a woma ad girl ad havig FGM. Recommedatio 4 (Better Awareess of Type 4 FGM) More awareess (especially through case studies) that type 4 FGM is also a form of child abuse ad agaist the law ad that it should ot be viewed as a alterative to type 1, 2 ad 3. Recommedatio 5 (Highlightig Idirect Impact of FGM o Me) Emphasisig to me ad boys that oe of the cosequeces of FGM is problems with sex ad relatioships such as the reluctace of wome i watig to have sex because of the pai ad a issue that will also impact them. Recommedatio 6 (Delikig FGM from Status ad Marriageability) Emphasisig that havig FGM does ot egatively affect marriage chaces highlightig that some me ad boys are agaist FGM ad do ot wat to marry cut wome. This is importat to highlight give oe reaso used to justify FGM is because it icreases the ma s sexual pleasure. This may also result i more support to ed the practice. Recommedatio 7 (Utilisig Voice of Survivors) Utilise the voice of survivors ad of wome ad me who are breakig the cycle of FGM (by ot subjectig their daughters to it) - local voices ca be more powerful. Recommedatio 8 (Tailored Campaigs for Differet FGM Commuities) Campaigs should be tailored to each commuity with activities used to robustly tackle the uderlyig reasos used to justify FGM without skirtig aroud some of the more sesitive reasos such as me s sexual pleasure ad faith. The hierarchy of reasos may vary from oe FGM practicig commuity to aother. O the other had iformatio campaigs highlightig there is o health beefit but a key reaso is because the wome believe it is what me wat, the agai this will have a limited impact. Similarly if uderlyig reasos are religio the these should be challeged robustly (see recommedatio 9). 44 Recommedatio 9 (Usig Religio to Challege FGM) If the uderlyig reaso for FGM is religio ad a broad-brush approach is used such as it is agaist faith ad actual texts ot challeged the there will be little impact as faith will always trump everythig. More detailed theological explaatios eed to be provided about why this practice is ot oly agaist the faith but also strogly codemed by it. Female Geital Mutilatio - Affected Commuities i Birmigham

45 Muslim Wome s Network UK Recommedatio 10 (Work with New Migrat Commuities) Targetted work with ew migrat commuities icludig boys ad me as they are more likely to wat to maitai culture ad traditio. Recommedatio 11 (Ivolvemet of Youth) Get more youth ivolved i schools icludig boys as peers may be able to have greater ifluece. This should iclude creatig youth champios that are at the forefrot of a campaig Recommedatio 12 (Extedig Airport Campaigs) Not restrictig police warig campaigs at airports to outboud flights to coutries of prevalece i Africa ad also fidig ways to sesitively target those travellig to other Middle Easter coutries particularly Dubai ad Saudi Arabia. Recommedatio 13 (Utilisig Medical Professioals as Ifluecers) Medical professioals such as doctors should play a importat role i efforts to support commuities to abado FGM by raisig awareess of its harmful effects ad health risks by speakig at commuity evets ad to ifluecers i the commuity such as religious leaders. Professioal Traiig Recommedatio 14 (Awareess Raisig i Primary / Juior Schools) Provide FGM traiig for goverors ad head teachers at primary ad juior schools so they are more receptive to allowig awareess raisig of FGM to their pupils, which should iclude givig assuraces that workshops ca be delivered usig age appropriate ad sesitive laguage. Recommedatio 15 (Idetifyig FGM through Health Problems) Doctors ad urses eed to traied to be vigilat i idetifyig medical problems that may be liked to FGM (ad ot just i idetifyig risk of FGM) so more girls ad wome are idetified so they ca receive medical ad therapeutic help. Health professioals also eed to be better at idetifyig FGM as a uderlyig cause of metal health issues that wome ad girls from FGM affected commuities may preset with. Recommedatio 16 (Specialist FGM Cousellig Service) Esure culturally sesitive psychological itervetios are made available esurig cousellors are traied o the issue of FGM icludig traiig wome from FGM affected commuities i cousellig. Recommedatio 17 (Mechaisms for Kowledge Trasfer) Staff turover amogst professioal is a risk for cotiuity i kowledge ad experiece of dealig with FGM cases. Mechaisms eed to be put i place to esure kowledge trasfer cotiues regardig prevetio, psychosocial ad medical care. Reportig Cocers Recommedatio 18 (Promotig how Reportig ca be doe Aoymously) Ecourage reportig of ay medical practitioers suspected of cooperatig i the practice of FGM icludig raisig awareess of aoymous ways of makig these reports. Recommedatio 19 (Promotig Third Sector FGM Orgaisatios) As people are more likely to report cocers to third sector ad wome s orgaisatios, such groups that deal with FGM should be promoted withi commuities. Recommedatio 20 (Role of Frieds ad Reportig) Esure girls i schools uderstad the importat role they ca play i helpig safeguardig their frieds. 45

46 Appedix 1: Wome survivors of FGM (Case Studies) All survivors iterviewed were of Muslim backgroud. All iterviews coducted Jue 2014 to April Case Study 1 Ethicity: SOMALI Age: 34 Type 3 FGM She has bee i the UK for 14 years ad has had type 3 FGM. She recalled her story: I was give a ew dress to wear ad this old woma ad my gradmother came to the house. My gradmother told me that I would be cleaed ad I would o loger be a girl, ad that God would be pleased with me. She also said: I will be like everybody else ad would ot be left behid. She broke dow whe she recalled how she struggled to close her legs while beig held dow. She said she was i pai for a week ad purposefully give little food or water. She explaied how her questioig about beig cut led to a agry respose ad was eve told it was a religious requiremet: Never tell ayoe, it is Islamic ad a Somali traditio ad those who speak about it, evil will come to them ad they will ever get the thigs that they wat. She says wome i the commuity icludig her mother believe it is a rule that must be adhered to regardless of the cosequeces of FGM: She thiks it is shameful to live with the geital area ope. She did ot disclose the exact age whe she had FGM but was less tha 10 years old. A major impact of her FGM was her periods because they would last a log time. I would start prayig ad my periods would start agai ad Ramada was the worst. My family would thik I was makig excuses ot to fast as I was ot sure whe my periods would stop. Aother major impact has bee that sex with her husbad is very paiful: At the begiig of my marriage I was beate a couple of times but my husbad is more uderstadig ow. She said that because it was embarrassig to talk about itimate matters, wome do t talk about these thigs. However, she expressed a iterest i watig to talk to other wome i her situatio. She broke dow agai durig the iterview. Whe she resumed the iterview she said that childbirth was very paiful too ad that she could ever put her daughters through this: I would ever allow my girls to go through this. I will ever take the back to Somalia or get them doe i a Arab coutry. She believes that some families may be takig girls to have FGM doe i Middle Easter coutries because the procedure is carried out i a sterile eviromet i.e. i hospital cliics. At the ed of the iterview she said this had bee the first time she had shared her story of FGM with ayoe. Case Study 2 Ethicity: ERITERIAN Age: 32 Type 1 FGM 46 She said she still remembers havig it doe ad uder 10 years old at the time. It was horrible ad paiful ad I do still remember although I try ot to. The old traditioal woma came aroud. She said that because she has had boys, she does t have to worry about FGM but feels that if she had daughters the the elders would have pressured her ito gettig the girls to have FGM: I feel that I would ot have bee able to challege our elders. She says that although she did ot have ay problems with deliverig her childre ackowledged that she did ot get sexual pleasure ad had problems with itimacy: Its just somethig you do to have childre. I m ot whole. I m ot itact. Somethig was take away from me. She said if she was cocered about ay girl i the commuity she would speak to a fried ad the cotact the school or wome s orgaisatio. Female Geital Mutilatio - Affected Commuities i Birmigham

47 Muslim Wome s Network UK Case Study 3 Ethicity: DJIBOUTIAN Age: 34 Type 3 FGM Although she was bor i Djibouti, she has bee livig i the UK for 8 years. She believes may girls i her commuity has had the severest form of FGM, type 3 ad she referred to it as Pharaoic ad said: All my cousis, my sisters ad my frieds have had the procedure. She said all of them have suffered health problems ad pai ad still do icludig difficulties it causes i their marriages. She also recalled the awful pai durig her weddig ight ad alluded to the fact that sex was paiful ad sometimes she did t wat to do it, but had o oe to speak to about it: It has created difficulty i my marriage. Sometimes I do t wat to, I am dry dow there, sometimes it feels so rough. I always feel sick but ot allowed to talk about it. She the recouted what happeed o the day she had FGM: I was 6 or 7 years old at the time. I took a special bath ad I was told to clea well dow there. My mum prepared the best foods ad I was give the best presets. My mother, my auties ad the cutter lady gathered aroud me. I remember there were also 8 to 10 ladies i the room who were waitig to hold me dow o the floor. I was so scared, I was ever told what would be happeig to me. Sice that day, which she says she still remembers very well, she has had to edure may health issues such as problems with her periods ad costat urie ifectios: Sometimes goig to the toilet is very difficult ad it takes a log time; I eed to go more frequetly or sped may miutes tryig to empty my self out oly to fid that I ve leaked already. Sometimes whe I lie dow it ca leak out. This is really very embarrassig for me. She said that she wated more doe to protect girls from this type of abuse icludig checkig girls from birth to teeagers, through physical examiatios. She said she was willig to call professioals icludig police if she kew a girl was at risk. Case Study 4 Ethicity: SIERRA LEONEAN Age: 34 Type 3 FGM She said that it is a strog traditio i her commuity back i Sierra Leoe ad because it is practiced by the Bodo secret society, she felt uable to talk about it for years. She had it whe she was about 10 years old ad still has ightmares: Some ights I still wake up with these dreams seeig that mask tellig me to swear that I ll ever tell ayoe. I remember it like it was just yesterday. She recalled how her mother took her to the village where she was greeted with sigig ad dacig ad could hear drums ad the a white sheet was tied aroud her body She the described what happeed: The wome from the Bodo society took the girls to the Bodo Bush. Whe I was cut, I screamed so much. Afterwards we (all the girls) had to agree to be part of the society ad to take care of our husbads. I was give ew clothes to wear ad was take back to my village. She said her life chaged after that momet ad her toys were take from her ad give to her youger sister. She said she would see the Bodo Devil (she was referrig to the masked wome she would see i her dreams). She still gets frighteed thikig about it ad gets ervous whe she sees a sharp tool or a blade. She says that sex was paiful whe she got married ad cotiues to be: I did t ejoy it at all ad would make all sorts of excuses ad this made my husbad really upset. Our relatioship would ed up beig difficult. I thik this is whe my depressio started. Sometimes to avoid sex I ow go to sleep early. She says she feels she has o choice but to just cope. 47

48 Case Study 5 Ethicity: SOMALI Age: 28 Type Not Disclosed She was bor i Somalia ad did t wat to say how log she had bee i the UK. She had FGM whe she was about 5 or 6 years old. She recalled how o the day she was give lots of attetio ad made to feel special: My mum bought me a lovely polka dot dress ad I had Hea put o my hads. My mom told me that all my frieds will be there ad that there will be a party with all my favourite foods. I could t believe it, it was t eve Eid Day but it felt like it. She recalls tryig to ask questios whe her mother was bathig her ad was told: Do t to talk to much, me do ot like wome who talk too much. She said she was the take to a room ad put o a table. She was held dow ladies whe it happeed ad ca still remember how paiful it was: The pai was ubearable. I kept askig what is this, the I screamed with pai ad the saw blood, lots of blood ad some ski. Afterwards she was told that she was clea ad perfect ow ad a good girl ow. She said that her mother ow regrets havig her cut ad has apologised ad ackowledges she was followig traditio ad ot religio. She said that she will ever forget what happeed ad keeps havig ightmares about the cuttig ad thought she could see the cutter whe she gave birth. Her doctor has told her she suffers from axiety ad has bee give tablets for her depressio. However, she said she wats to talk about it ad there are o support services for wome like her. She said more actio is eeded to idetify wome who have had FGM such as idetifyig ad recordig it durig a cervical smear. She also felt that youg girls were ot beig adequately protected ad gave example of how o oe has checked up o her daughter: Whe my daughter was bor i 2010, a health visitig team came to see me. They produced a gree form regardig FGM. I was give reasos for ever havig it doe to my daughters, here or back home. To this day obody has ever come back to check o my daughter. I could have goe back home ad had the cut doe o my daughter ad obody would have kow. These checks have to be doe regularly. She also metioed we eed to follow Frace because they do more checks. She said o checks happe o those returig from abroad. She also suggested that forms should be siged (by families) statig that FGM will ot be carried out o their daughters. She is so agaist FGM that she said she would iform the police if she kew a girl was at risk. Case Study 6 Ethicity: SIERRA LEONEAN Age: 34 Type Not Disclosed She recalled how she wet through the Bodo ceremoy whe she was 10 years old ad felt apprehesive speakig about it: I m ot sure if I should be tellig, I hope othig happes to me ad my family. There were quite a few of us that were led to the ceremoy (by wome), you kow it s a rite of passage for wome from childhood to womahood. She said that the ceremoy was ot explaied to her ad remembered beig really scared ad the gettig shocked: Whe I was cut, I was bleedig very heavily ad they put ash i that area. I also remember havig a fever. She says every time she has a fever ow, it remids her of that time i the bush. She said that whe she came out of the bush she was give moey ad gifts ad there were celebratios. She still feels axious about it as it is still i the back of her mid but whe she goes to the doctor she ever metios her cuttig: The doctor just recommeds I try ad go for a walk ad perhaps exercise. He has ever asks me about my childhood or why I feel like this. 48 Female Geital Mutilatio - Affected Commuities i Birmigham

49 Muslim Wome s Network UK Case Study 7 Ethicity: SOMALI Age: 43 Type 3 FGM She was bor i Somalia ad has bee i the UK for about 13 years. She said her father was agaist it so her mother carried it while he was out for most of the day. Afterwards whe he foud out, she said he early divorced her mother. She said the female cutter, who worked i a local hospital as a cleaer, had stole some eedles ad aaesthetic from there. She explaied how she has had FGM carried out o her three times while less tha 10 years old. She said the first time she was left bleedig ad her mother had to take her to hospital: She put the eedle i to paralyse the lips but she ijected it i the wrog place ad the cut the clitoris ad tissue. She the sewed me ad tied my legs. I bled so much that I thik she cut my mai artery so my mum took me to hospital where I had to stay overight. She said her secod FGM was whe the cutter retured a week later to check ad said she had to redo it as the areas was ot sealed properly because the areas had ope up. It was doe a third time because she fell dow while she was playig ad started bleedig: A differet woma came ad used herbs ad the thors from the tree - I remember it as though it was happeig ow. As she told her story ad described the severe pai she kept breakig dow. She says the cutters carry o cuttig eve whe their eyesight becomes poor. She explaied she has had problems with her periods sice childhood ad had to be cut ope the ight before her weddig ight: The first ight was horrible, I bled a lot. I Somalia they cut you ad the husbad must sleep with the wife o the first ight, otherwise he is ot a cosidered a complete ma ad this is doe to avoid shame. She says sex is still paiful ad she has to sit i cold water afterwards every time but sometimes she makes excuses. She says oe impact of FGM is domestic violece: Me do t uderstad the pai for wome ad ed up beatig their wives ad they just accept this as a way of life. She has also suffered each time whe givig birth to her four childre, all bor through caesarea: I gave birth i Norway ad o oe has see a mutilated vagia before. Five or six doctors came to look at the area. I felt so humiliated ad embarrassed. If she foud out someoe was at risk she would report it to the police but says that she has heard that pichig is doe to those who do t go abroad. She hopes the commuity will talk about it more but wo t because it is see as shameful ad she herself would like to help raise awareess by possibly speakig about it. Case Study 8 Ethicity: EGYPTIAN Age: 62 Type Not Disclosed She said she had her FGM doe whe she was about 9 years old ad that it was her mother who had decided with her father that this was goig to happe. My family were from a rural area ad i those areas i order for a girl to be moral you have to have this doe. She says she still remembers it ad was doe by a lady they referred to as daya who was like a midwife. It did hurt whe I had it doe, but I had o choice. I remember beig shocked ad I kept askig what are you doig? I ca t remember what she used but I ve ever felt pai like that. She remembers the reasos her mother gave her for it such as religio, for clealiess, ad because that is what husbads wat whe you get married: She said we would get good marriage proposals from me who were educated ad had moey. She did ot seem to have health problems ad said it did ot affect the delivery of her childre. She also felt because people were more educated ow it did ot happe (i the UK). 49

50 Case Study 9 Ethicity: SOMALI Age: 37 Type 3 FGM She was bor i Somalilad ad has bee i the UK for 25 years but had her FGM doe before arrivig i the UK whe she was 4 years old. She says whe she is aloe she still thiks about it ad sometimes certai thigs will trigger the memories such as the smell of Dettol. However, her opiio has chaged over time: If you asked me 10 years ago, I would have said its ok ad probably would have had my daughter doe too but ow, ever! She chaged her mid whe she foud out that it could ot be justified o religious grouds ad that it was a cultural traditio. At first she said she used to be proud of it despite the pai ad explaied that girls who have had the most severe type will feel more superior to those who had the lesser types: I used to walk i proud - makig them (those who had pichig) feel less tha me, I was suppressig my feeligs ad showig that I ve bee brave ad cut properly whilst they have just bee piched ad still remai uclea. I thought they were lower class tha me I was proud that I was able to go through the worst type of cuttig. She said she is agaist it ow ad her ad her husbad would ever do this to their daughters. Although she is agaist FGM she said: I still believe it stops girls from beig promiscuous ad messig about because you are flat. She recouted what happeed whe she got married ad that there is pressure o me to have sex eve if she is i pai: O the ight before the weddig I was cut ope for my husbad so that he could egage with me. It is really importat for a ma to be able to peetrate a woma durig the ight of the weddig as this shows his masculiity. She believes that all wome i her commuity have had it doe ad says she had heard that girls used to be take to other UK cities such as Sheffield ad Hull to get it doe but ow girls are beig take to Dubai or Egypt so it ca be doe uder aesthetic. She remembers oe childhood fried beig take to Oma to have it doe. She was t aware of ay specific details or iformatio that could be passed o ad it was just what she has heard. Case Study 10 Ethicity: SUDANESE Age: 37 Type Not Disclosed She recalled her experiece ad remembered beig forced to lie dow o some old mattresses o a agareb (a woode bed). She said she could still remember what the woma, who sat o a low woode stool, said to her: She told me I was ow goig to become a woma ad said real wome ever cry. She the said she was goig to remove dirt ad make me clea so I become a real Muslim. She the wet o to explai how other wome grabbed her arms ad legs ad held her dow ad covered her eyes. They also remided her that her sister ad cousis had also had it doe. She did ot cofirm her age whe she had FGM but was uder the age of Female Geital Mutilatio - Affected Commuities i Birmigham

51 Muslim Wome s Network UK Case Study 11 Ethicity: GAMBIAN Age: Uder 16 Type Not Disclosed Oe mother cotacted the researcher aoymously ad withheld her telephoe umber to share the story of her daughter. A couple of years previously, her mother i law kept puttig pressure o her (ad her husbad) to take their daughter back to Gambia for a visit. The mother i law said she was ot well ad wated to see her grad daughter. She explaied how they gave i to the mother i law s demads ad her husbad took their daughter for a holiday to Gambia where she was subjected to FGM (whe left aloe with family members): I was t there for my daughter; her aut ad gradmother got this doe. I do t kow what my poor child has goe through. She did ot disclose the age of her daughter but idicated she was uder the age of 16. She was too frighteed to give details because she realised what had take place was agaist the law ad was worried about gettig ito trouble but wated to share her story so others could lear from it. Case Study 12 Ethicity: SOMALI Age: 31 Type Not Disclosed She was take back to Somalia to have it doe whe she was 6 or 7 years old. She says it was her stepmother ad gradmother who wated it doe ad arraged it despite her dad beig agaist it. O the day she was told to take a bath because she was goig to be circumcised ad that she would be gettig ew clothes ad her fried would be gettig it doe too. She explais how she felt excited because she did t kow what was goig to happe ad eve offered to go first. She the described what happeed ext: The lady who came was old ad took a blade out of her box. I became scared ad tried to hide. They caught me. It was very bad. They tried to hold me dow ad they cut me. I had so much pai afterwards ad was shakig. Afterwards I could t walk ad I could ot go to the toilet, I forgot about my ew dress. She said her dad was upset whe he foud out ad feels she ca t forgive her stepmother. She said that she does t kow what happeed to her fried because she ever saw her agai ad recalls her beig take to hospital ad her family beig very upset. She thiks her fried may have died because whe she asked about her she was told ever to metio her agai. She wet o to explai that her ordeal did ot ed there ad icluded health ad marital problems: Whe I had my period I was always i so much pai. Whe I got married a couple of ights before my weddig I had a small cut agai; it was so paiful. I cried so much. O the ight of my weddig it was so paiful ad the pai carried o for moths. I did t kow what I could do to heal it, so I tried to be asleep most ights. As I was t havig sex my husbad he told I was t a good woma. I could feel pressure to have sex whe I did t wat to. She the said that whe she became pregat her baby was still bor ad the she was blamed for it. However, she decided the that if she ever had daughters she would ot put them through it. However, her husbad did ot agree with her ad worried about what the commuity would say. She said her marriage evetually eded because of the domestic violece that was associated with her FGM: My husbad would hit me whe I would ot sleep with him ad I could t take it aymore ad we separated ad fially divorced. I do t care for a ma ow - my mid is ow free. Although she said she is brigig up her daughter ad sos to challege this traditio of FGM, there are others i the commuity who are stigmatisig her: Both my eighbours are Somali ad they wo t let their childre play with my daughter because she is ot circumcised eve though oe of the girls is her best fried at school. 51

52 Case Study 13 Ethicity: SOMALI Age: 34 Type 3 FGM She says she really resets what her mother put her through: I hate what she has doe to me, may Allah (God) forgive her. She had doe whe she was 6 years old. She said her mum decided it was too much moey to get it doe i the cliic so this old lady came to the house istead. She recalled how her legs were boud for days ad she could t go to the toilet. She says she has really suffered because of her FGM ad would like to talk to someoe about it: I hate ayoe touchig me ad I had to have both of my boys via caesarea. She says she feels blessed that she has sos so she does ot have to thik about FGM although she added she would ever do that to a daughter if she had oe. Case Study 14 Ethicity: SOMALI Age: 42 Type 1 FGM It was the first time she was speakig about her experiece ad therefore felt apprehesive: Allah (God) forgive me that I am talkig about it ow. She says she was happy up util the age of 7 but the she had FGM ad felt as if her dreams stopped after that. She remembers that she stopped speakig immediately afterwards. She says she still remembers the cutter ad feels really agry every time she recalls that day. She admitted that it has impacted her relatioship with her husbad: I have o feeligs for my husbad, I thik it is because of the cuttig. The experiece cotiues to affect her metally: If I see my husbad s razor, it remids me of that time. After talkig about her feeligs she said she Would like to talk to others who have had similar experieces but said it was t the doe thig. She has 6 childre ad says she would ever put her daughters through FGM. Case Study 15 Ethicity: YEMENI Age: 17 Type 4 FGM She said she had a medical procedure i Saudi Arabia as her family used to live there prior to movig to the UK: I cat remember how old I was but I do t mid that I have had it doe. It was othig much, just a little cut ad makes o differece to me. It is ot like i other commuities where it is cut off ad the everythig is kitted up back together. She said that her family did ot make her youger sisters have it doe after movig to the UK. However, she said that she has heard that the practice does take place i the UK: There is some private cliic i Lodo, owed by a Arab, that was doig it. I eve heard about a relative, who i her 20s who did ot have it doe as a child but wated to get it doe. She wet to a GP that was also from the same backgroud ad asked him if he would do it for her. She did ot kow whether this relative was successful at gettig the FGM doe. 52 Female Geital Mutilatio - Affected Commuities i Birmigham

53 Muslim Wome s Network UK Case Study 16 Ethicity: NIGERIAN Age: 52 Type 2 FGM She had accompaied her fried while she had talked about her experieces. But decided to make cotact by phoe to iform us that she had FGM too: Well I was t goig to say aythig but I had it doe but it has t affected me. I am from the Yoruba tribe ad we practice type 1 ad 2. She said regardless of the type, it was causig problems with their husbads: We are ot too active; it does cause problems i the bedroom. I do t feel aythig. 53

54 Appedix 2: Wome who have ot had FGM (Case Studies) All survivors iterviewed were of Muslim backgroud. All iterviews coducted Jue 2014 to April Case Study 1 Ethicity: SOMALI Age: 34 She was bor i Hollad ad has bee i the UK sice She said that she has ot bee cut because her father, who she says is very religious, was really agaist it. She said that he had wared her mother ot to do it. The family have ot retured to Somalia ad oe reaso was due to the fear of cuttig. She said that there are other wome i the family who have bee through FGM ad believes some i Birmigham still do practice it because it is such as old traditio but would be willig to speak to someoe about it if she became aware if someoe was at risk: I would probably speak to a health worker or a wome s orgaisatio. Case Study 2 Ethicity: GAMBIAN Age: Ukow She has bee i the UK for 5 years. She said that she did ot have FGM because her mother kew it was ot ecessary because she was educated. She said at the time they were livig i Gambia with oe of her auties who also did ot believe i FGM. However, she said that people i the commuity were aware of it which led to her beig ostracised ad bullied: I remember the bullyig itesified whe oe of the girls stood outside the toilet ad had probably heard that I was t tricklig but was gushig. Whe I came out she told me I was uclea ad impure ad she wet ad told the other girls ad they stopped hagig aroud with me. She explaied how there were groups of girls at school who had FGM doe ad whe she felt isolated wished she had it doe too ad felt the same whe she got married: To fit i I wish I had had FGM doe to me. Also felt it whe my first marriage broke dow because my husbad thought I d bee sleepig aroud because I was t cut. Case Study 3 Ethicity: SOMALI Age: 24 She has ot had FGM but puts it dow to her father but thiks her mother did ot share his views: My dad told me its haram (ulawful) ad it s completely agaist our religio, however my mother o the other had has stayed quiet. She said that although she has ot really aware of others i the commuity who have had FGM doe she says the practice is still cotiued i Somalilad: Some of my cousis who have come over from Somalilad have had FGM doe. She was very strogly agaist FGM ad said it was a outdated traditio which had o place i todays society ad wated more awareess raisig o the illegality of FGM. However, if she had cocers she said she was more likely to cotact a wome s orgaisatio about it. 54 Female Geital Mutilatio - Affected Commuities i Birmigham

55 Muslim Wome s Network UK Case Study 4 Ethicity: INDONESIAN Age: 34 She said she had ot bee subjected to FGM as she had lived i the West all of her life. However, she said that it is also happeig i Idoesia particularly amogst coservative areas: It is apparetly wajib (obligatory) ad doe to prevet promiscuity. She said the practice was carried out more amogst poorer families because they thik it is more hygieic: They thik it cleas the filth from geitals ad also cotributes to a girl s growth. Case Study 5 Ethicity: SOMALI Age: 22 Although she was bor i Somalia, she lived i the Netherlads before movig to the UK ad has bee livig here for the last 12 years. Although she has ot had it doe, she says her relatives have had it doe back i Somalia. She did t just blame the older geeratio but also felt youth eeded to make the chage: This is a outdated practice ad we ca t blame the older geeratio ad we are the oes that have to chage the root causes. She said she would defiitely alert professioals if she had cocers about ay girl. Case Study 6 Ethicity: INDONESIAN Age: 23 She has ot had FGM but her older sisters had it before they came to the UK from Somalia. She said whe she was a teeager she felt left out because whe her sister s would talk about it, they would t let her be part of the coversatio. She said she felt eve more left out whe she became aware that her frieds at school had bee cut (before arrivig i the UK): I thought I was missig out ad really wated to have it doe ad kept askig my mum to let me get it doe. However, she said she got put off whe oe of my sister s spoke about the health problems she faced durig her childbirth. She said this was reiforced by a documetary she watched o TV ad ow feels lucky she did ot udergo FGM. Case Study 7 Ethicity: SOMALI Age: 17 She wet back to Somalilad whe she was 14 years old ad to lear about her culture. Whe she spoke to girls of her age, they said that they had o choice to have it doe because if it was ot doe it was result i bullyig. Durig her stay she was also pressured by girls of her age to have it doe but did ot succumb to the pressure. 55

56 Case Study 8 Ethicity: SOMALI Age: 20 Whe she was a teeager, her father suggested that her ad her sisters should be cut to silece them because they had started to aswer back ad were talkig too much. Her mother the arraged for a appoitmet for all of them to be cut at a hospital i Dubai. My mum offered us all 250 to have it doe. We agreed to this. We were told othig about the type of FGM we were goig to have but just told that it s the Sua it is the oe which is ok ad as it s doe i a medical facility. However, she said that after travellig to Dubai, there was a mix up with the appoitmets ad they could ot get it doe ad reschedulig could ot take place durig their stay. She said they all retured without havig FGM. 56 Female Geital Mutilatio - Affected Commuities i Birmigham

57 Muslim Wome s Network UK Appedix 3: Wome s focus group A focus group was held with the aid of a Arabic traslator with 6 wome (four Yemei ad two of Egyptia backgrouds) who were i their 50s, 60s ad 70s. Below are the sigificat commets from the most vocal wome: Case Study 1 Ethicity: Egyptia Age: 54 She was ot sure which oe type of FGM she had doe i her coutry of origi but recalled beig take to a hospital. She said she ca t remember much about it ad that the FGM has ot affected her. She says her frieds have also had it doe ad do t complai about it but added that they do t talk about such thigs. She also did ot feel that it was a serious issue: It is a very old traditios ad I feel that the West is makig a big deal about FGM. Case Study 2 Ethicity: Yemei Age: 52 Although she did ot feel cuttig takes place i the UK but cotiues i rural parts of Yeme, she thought the procedure was acceptable providig it was medicalised but the said: The educated will kow we should t do this to our girls. Case Study 3 Ethicity: Yemei Age: 61 She could t remember how old she was whe she had FGM because of her age. She said her frieds (who are from the same rural areas i Yeme) had it doe too. She explaied girls would have khita doe i their homes usig a razor ad said it was for protectio: My dear old mother used to say it was to protect me util my weddig ight. She expressed discomfort about havig to talk about her body: I do t eve kow if I should be takig about this; it s a shameful whe you have to talk about your body like this. However, she said she was agaist cuttig ad would speak to others if she had cocers. 57

58 Appedix 4: Me from FGM Affected Commuities (Iterviews) Iterview 1 Ethicity: SOMALI Age: 34 He has bee livig i UK for the last 25 years ad is aware of FGM: Whe I used to live i Lodo I used to hear about girls beig take abroad i the summer. Although he felt sad for the girls ad uderstood that FGM was life destroyig ad cosequeces life log, he said if he kew it was takig place, ay actio he would take would deped o the age of the girl: I would ot ivolve police due to sesitivity but would be willig to speak to a third sector orgaisatio. He said it was doe i the ame of traditio ad ot Islam ad felt the mai istigators were wome while me are aware but claim igorace. He also could t uderstad why me were t sayig aythig because it affected them too: If she does ot have ay feeligs, the what s the poit? I do t ever wat to marry ayoe from our commuity. He suggested more coversatios with families ad commuity were eeded ad was eve willig to arrage a male group to discuss the issue. Iterview 2 Ethicity: SUDANESE Age: 58 He was agaist FGM ad ackowledged that his religio does ot codoe it ad would be willig to get help he kew someoe was at risk. His attitude was iflueced by the experieces of his wife. He recalled whe his wife gave birth for the first time i Norway: The baby would t come out ad my wife was screamig. I thought she was goig to die. The doctors came ad started lookig at her private area ad the decided to perform a emergecy caesarea. They explaied it was because of FGM why the baby would ot come out. The experieces of his wife made him more aware of the impact of FGM. While he was workig i the NGO sector he said whe he came across wome who had FGM, he would help them get medical treatmet: Oe lady who had her whole area cut ad sew back hardly had ayway to uriate or mestruate. He said there was a eed for a space where me could speak to each other whose wives had bee cut: It is a taboo subject ad will remai so if we do t opely have discussios about it. Iterview 3 Ethicity: GAMBIAN Age: He provided examples of the ethic tribes i Gambia i which FGM was prevalet such as the Madika, Jola ad Fulla tribes. He also explaied why the females i his family had it doe: My wife had FGM, as well as all the girls i her family otherwise they would have bee ostracised. He blamed the wome i his commuity: Me have iformatio hidde from this them. My father was really upset whe my sister had it doe. He was a religious ma ad really agaist it ad threateed to divorce my mother if she did it agai to ay of the other daughters. He broke dow whe he said that he was uable to help his sister at the time. Female Geital Mutilatio - Affected Commuities i Birmigham

59 Muslim Wome s Network UK He has five daughters but they have ot bee cut because he ad his wife do ot believe i it. However, he says his mother i law back i Gambia keeps cotactig them askig them to brig their daughters back to get them cleaed. Now he o loger allows his daughters to speak with their gradmother. He started to speak out about FGM withi the commuity but is less vocal ow due to fierce criticism ad itimidatio he has received from people from withi his commuity here, ad i Gambia. Iterview 4 Ethicity: SOMALI Age: 47 He is a local imam ad says that it is agaist Islam ad would ot subject his daughters to it. He explaied that he was uaware of the practice whe he was a youg boy growig up i Somalia. Although he is aware that the females i his family have had it doe he feels ucomfortable talkig to them about it: I my family my sisters have had it doe ad my wife has had the cuttig, but I have t had a coversatio with her about it. He said that too may people i his commuity thik it is a wome s issue so me do t talk about it ad it is about time religious leaders were provided traiig o this issue: We do t get taught about issues that affect wome. I kow that may of the couples that come to me for issues such as domestic violece that result from bedroom issues, ad most probably we have to ask the questio why is this? Iterview 5 Ethicity: SOMALI Age: 33 He is a imam ad has ot bee i the UK for log ad has spet may years livig i Europe. He said that he was agaist FGM ad explaied that whe he was ready for marriage, he did t wat to marry ayoe who had bee cut: I asked for someoe who was ot cut, ad equally I will make sure that my daughters are ever cut. However, as the coversatio progressed he said although type 3 FGM was defiitely agaist Islam, types 1, 2 ad 4 were more accepted amogst some religious scholars: I have to do more work ad uderstad types 1, 2 ad 4 myself. Iterview 6 Ethicity: SOMALI Age: 34 Prior to livig i the UK, he had lived i Hollad ad Norway. He became aware of FGM whe his family (j Somalia) requested moey for it: I was the sole breadwier sedig moey back to my family regularly ad they asked for moey to buy my sister clothes, jewellery, food ad for a old lady to orgaise the ceremoy. He said whe he questioed what this ceremoy was, he was told girls become wome after this ceremoy. He said although he did ot uderstad what FGM was at the time but he does ow ad would ot marry ayoe who has had it doe: I am ot married so there is o poit i gettig married to someoe who has had this doe, what pleasure do they feel, if this is take away from them. 59

60 Bibliography Asmai, I,L., ad Abdi, M,S. De-likig Female Geital Mutilatio/Cuttig from Islam, Populatio Coucil, Available at: fial%20report.pdf BBC News. 'Geital mutilatio' doctor struck off after udercover press stig, 30 May Birmigham Violece Agaist Wome Board. Birmigham Violece Agaist Wome Strategy ( ), Available at: Birmigham Health ad Wellbeig Board. A Summary of the Joit Strategic Needs Assessmet for Birmigham, British Medical Associatio. Female Geital Mutilatio: Carig for Patiets ad Safeguardig Childre, Castlema, M. Does Circumcisio Reduce Me s Sexual Sesitivity? Psychology Today, 2 October Available at: Dowlig, K. Detist struck off for offerig female mutilatio, The Suday Times, 8 September Available at: FORWARD. A Statistical Study to Estimate the Prevalece of Female Geital Mutilatio i Eglad ad Wales, Available at: FORWARD. Female Geital Mutilatio - Iformatio Services ad Support Guide, Gov.uk. Faith ad commuity leaders uite to codem FGM, 20 Jue Available at: HSCIC. Female Geital Mutilatio (FGM) - October 2015 to December 2015 Experimetal Statistics, 8 March Available at: Laville, S. Doctor foud ot guilty of FGM o patiet at Lodo hospital, Guardia, Macfarlae, A., ad Dorkeoo, E. Female Geital Mutilatio i Eglad ad Wales: Updated statistical estimates of the umbers of affected wome livig i Eglad ad Wales ad girls at risk Iterim report o provisioal estimates, City Uiversity of Lodo, Mahmood, M., ad Mills, E. I ca circumcise them here: 750 for the first daughter, The Suday Times, 22 April Rashid, Q. FGM Is a Act of Terrorism -- Not a Act of Islam, The Huffigto Post, 3 July Available at: Rawliso, K. Police obtai first FGM protectio order, The Guardia, 17 July Scottish Refugee Coucil. Briefig for MSPs o Female Geital Mutilatio (FGM) Members Debate, 5 Feb Female Geital Mutilatio - Affected Commuities i Birmigham

61 Muslim Wome s Network UK The Europea Parliamet. Europea Parliamet Resolutio of 24 March o Combattig FGM i the EU(2008/2071(INI), Available at: UNFPA Egypt. FGM i Egypt, o date. Available at: Egypt_Prevalece_rate_ad_Prospects.aspx UNICEF. Female Geital Mutilatio/Cuttig: A statistical overview ad exploratio of the dyamics of chage, 2013: Available at: West Midlads Police. I Focus: Force determied to break dow FGM wall of silece, 30 September Available at: West Midlads Police ad Crime Pael. Tacklig Female Geital Mutilatio i the West Midlads, Available at: World Health Orgaisatio. Fact sheet 241, Updated Feb Available at: 61

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64 Muslim Wome s Network UK The Warehouse / Alliso Street Digbeth / Birmigham / B5 5TH