FGM in the UK: contextual issues and challenges

Transcription

1 FGM in the UK: contextual issues and challenges SHAKTI AGM- 4 th December 2009 Dr Monica E.M. Mhoja Dignity Alert & Research Forum Ltd (DARF) 30 Westburn Glove Edinburgh EH14 3JN dignityalert@hotmail.co.uk Member- Board of Trustees FORWARD

2 Outline of presentation FORWARD at a glance Introduction to basics of FGM FGM Classifications; Prevalence FGM Socio-cultural context Health consequences of FGM Making a case against FGM FGM in the UK- what we know What strategies have been adopted to date Meeting needs of vulnerable women & girls Challenges

3 Who we are FORWARD works to safeguard and advance dignity and rights of African girls and women globally FORWARD s vision is that women and girls live in dignity, are healthy and have equal choices and opportunities to fulfil their potential We aim to inform, advocate and empower

4 What we do [UK & European Programme] Mobilise communities and engage young people Undertake policy advocacy & campaigns Provide training, advice & information Undertake research

5 What is FGM? According to WHO FGM refers to: All procedures which involve the partial or total removal of the external genitalia or injury to the female genital organs whether for cultural or any other nontherapeutic reasons

6 WHO classification of FGM Type I : Excision of the prepuce and part or all of the clitoris Type II : Excision of the prepuce and clitoris together with partial or total excision of the labia minora Type III : Infibulation Excision of part or all of the external genitalia and stitching of the two cut sides together to varying degrees Type IV: Pricking, piercing, incision, stretching, scraping, or other harming procedures on clitoris or labia, or both

7 The Global Magnitude of FGM / FGM in UK WHO estimates show that annually 3 million girls and women undergo FGM round the world and over 140million women and girls have undergone the practice to date. UK: The joint FGM study led by FORWARD estimates that about 23,000 girls under 15 years may be at risk of FGM or have already undergone FGM Total numbers of women who have undergone FGM in England & Wales is estimated as 66,000. % Increase in number of maternity cases with FGM increased from 1.06 in 2001 to 1.43 in about 6,000-9,000 women- 44%» Source FORWARD 2007

8 Socio-cultural context of FGM Culture, tradition that is what we..do Religion viewed as religious obligation-a good Muslim/ Coptic Christian/ Ethiopian Jew Purity, chastity, fidelity, honour Aesthetics and hygiene the vulva in its natural state is considered unattractive and unclean Gender identity and expectations of what is a good woman, sexually not demanding- makes women calm. FGM confers status & credibility.

9 Health Consequences of FGM Many women are not aware or fail to make the links to the health effects of FGM FGM leads to short term and long term health complications, particularly sexual and reproductive health. In some cases this may result in severe haemorrhaging and death

10 Obstetric Complications due to FGM WHO Study 2006 Long-term adverse effects may include abscesses, painful cysts and thick, raised scars called keloids, which can, in turn, cause problems during subsequent pregnancy and childbirth. Women who have type 3 tend to require being stitched after each birth Increased Cesarean section due to delivery complications; Experience more postpartum hemorrhage; Tend to require episiotomy; Results in extended hospital stay; Infants often require resuscitation; Infants of mothers with extensive form of FGM at increased risk of dying at birth

11 Making a case for collective action to end FGM FGM is a growing concern in the UK Silent pain for many women & young women There is strong evidence on the adverse impact on health and wellbeing

12 FGM is a human rights concern Violates Convention on Elimination of All Forms of Discrimination Against Women (CEDAW) Negates the Convention on the Rights of the Child-right to equality and to freedom from mental and physical violence Interferes with the right to attain the highest standard of sexual & reproductive health Affects the right to be free of cruel and degrading practices- results in severe pain

13 Globally change is happening There is a new global action to end FGM in one generation led by UN agencies 18 African countries have laws against FGM UK and many European countries have introduced specific FGM laws Many Islamic scholars have stressed that FGM is not an Islamic obligation Maputo Protocol on African Women s rights calls for action against FGM and child marriages

14 The context of FGM in the UK: What do we know? FGM in numbers in the UK The FGM study conducted by FORWARD in 2007 indicates that about 24,000 girls under 15 years may be at risk of FGM or have already undergone the practice Total numbers of women who have undergone FGM in England & Wales is estimated as 66,000. Five women were found to have died from complications of FGM in the 2007 enquiry on maternal deaths- Department of Health

15 Communities at most risk Kenya- 18,518 Somalia- 15, 272 Nigeria- 6,925 Sierra Leone- 5,963 Egypt- 3, 592 Sudan- 2,879 Ethiopia Eritrea- 2,545 Tanzania Ghana Source FORWARD 2007

16 Women s psychological experiences Studies conducted on immigrant and refugee women found that majority remembered their experiences of FGM, providing detailed accounts Post traumatic stress disorders including sexual problems, depression and anxiety in some women Factors that helped women included recollection of the event as negative or positive; Presence of community support Presence or absence of anaesthetic Source; Haseena Lockhat- 2004; DARF

17 Factors motivating FGM To suppress female sexuality (before and during marriage) To make sex more pleasurable for men To clean/purify women (uncircumcised women portrayed as dirty ) Cultural identity: tradition of FGM is older and more important than the concerns of any individual To ensure marriageability Religion did not emerge as a credible rationale = Numerous interconnected reasons individual health argument is not always highly relevant to those supporting FGM Source: FORWARD 2007; DARF 2009

18 FGM who decides? Mothers under huge pressure from older female relatives back home and some older women in the UK Women fear female relatives will circumcise daughters against their will back home Mothers have to be highly motivated and assertive to resist ongoing pressure Seen to be women s business father escapes pressure to circumcise daughter Women who decide not to circumcise their daughters may face ongoing internal doubts especially if they plan to return to original country Families may fake daughter s circumcision to avoid pressure

19 Experiences of FGM All the women voiced the pain they felt, starting from the day they were cut Many felt that no one cared about their pain & that they suffered alone FGM & sexual feelings were viewed as taboo

20 Difficulties in seeking help People don't say if they have psychological problems they wouldn't admit it. People would think they are mad, and it s the same with sex therapists, people would never go. They would never do that, people think it is wrong to talk about sex, especially for women, very wrong. They fear that if they tell the midwife or another health professional that they will not understand our culture and tradition and think that we are illiterate or have bad traditions.

21 Experiences with Health Services During my pregnancy at Saint Mary s I had informed the midwife of my circumcision. On my due date, that midwife was not there. The new midwife took one look at me, and when she saw my circumcision she began screaming, saying Oh My God. She even pressed the alarm. Woman in London

22 Experiences of Health Services There is this lady who has been circumcised. When she was pregnant, she attended the local health centre. When she gave birth to her baby girl, they sent her a letter telling her not to circumcise her daughter and that if she circumcised her, it would be against the law and she could go to jail. The woman found the letter threatening, and she was very angry because she did not intend to circumcise her daughter. She was angry that the authorities assumed this just because she was circumcised. She wished the authorities had confronted her about her intentions instead of threatening her without knowing anything.

23 Interacting with Health Services in UK Many felt shy, ashamed, lose their confidence when examined women feel different from other women & wonder what doctors think of them Because of FGM many women have difficulty to visit their doctors Its embarrassing especially when we are asked why we did this to ourselves, we don t have an answer

24 Recommendations Raising awareness and discussion: Breaking the cycle of silence Bringing men s voices into the debate (counter assumption that all men want circumcised wives) Questioning assumptions (e.g. circumcision protects virginity) Supporting families who choose not to circumcise daughters (e.g. peer support) to counter ongoing pressures to circumcise

25 Recommendations Improved communications channels: Ensuring people have readily available and accurate information Information must be sensitive and available for all educational levels Women themselves had numerous ideas for accessing the community, holding discussions etc. GP surgeries identified as key point for information

26 Strategies adopted in the UK for responding to FGM in the UK

27 The new UK Law on FGM The Female Genital Mutilation Act 2003 applies to England and Wales; Scotland has its own legislation on FGM (the Prohibition of FGM (Scotland) Act 2005) The new Law introduces three main changes: 1. extraterritoriality 2. increased penalty- from 5 to 14 yrs imprisonment or a fine or Both 3. changed name to FGM from FC

28 Female Genital Mutilation Act 2003 Offence to commit FGM Offence to aid, abet, counsel or procure a girl to commit FGM Offence for someone in the UK to aid, abet, counsel or procure FGM outside of UK that is carried out by a person who is not a UK national or resident Any act done outside UK by UK National or resident

29 Limitations of the UK Law Technically the law allows for surgery to the external genitalia if it is for the purpose of tackling sexual confidence, body image and self esteem. The law does not provide much protection to those who are not UK citizens or permanent residents

30 Influencing FGM strategies Health and specialist services Child protection approach Policy advocacy Research Multi agency partnerships Working with religious leaders Training and public education Community engagement Young people as advocates

31 Framework for action To mobilize community stakeholders in the design, implementation & evaluation of programmes Participation, empowerment, safeguarding and accountability Engage with young people as advocates Promote women s rights, leadership skills & other SRH concerns Mobilize on harm of FGM and rights of children Multi-agency partnerships and collaboration Coordinating programmes and lesson sharing

32 FORWARD S YOUNG PEOPLE SPEAK OUT PROJECT

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34 Challenges & Issues Lack of skills and knowledge of FGM among key agencies. Lack of reliable data to support policies and initiatives for women and girls living with FGM Lack of awareness of available health services Linguistic and cultural barriers for women and girls leading to exclusion and reticence to make use of health services No government coordination & guidance or plans Inadequate funding for community programmes Challenges in enforcement of FGM law Lack of clarity around FGM as grounds for asylum

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