Female Genital Mutilation: Why Does This ‘Holiday’ Horror Endure?

‘Summer Holidays are for Fun not Pain’ declared the (London) Metropolitan Police Force as school broke up for the Summer 2012 break. A strange thing to remind us, we might think; everyone knows the Summer Hols are for fun. But then perhaps we recall that hundreds, if not thousands, of young British girls are forced to undergo female genital mutilation (FGM) during that long break when school is out. Hence the message of the Met’s London Safeguarding Children Board…..

This paper is a more detailed version of a post with the same title published by the Huffington Post.

Please sign the HM Government e-petition to STOP Female Genital Mutilation (FGM / ‘cutting’) in Britain, and ask everyone else to do the same. Thank you.

……   Nonetheless, school is now back but FGM continues; and as well as those UK-based children who are taken elsewhere for this purpose during the so-called ‘cutting season’, we now learn there are even children being brought into the UK from mainland Europe for gruesomely-named ‘cutting parties’, because shamefully Britain is perceived to be less vigilant about preventing FGM, than are our European neighbours.

In my original Huffington Post blog on this difficult subject, I asked why female genital mutilation continues in the UK without to date any successful legal action, despite the certain knowledge that there are thousands of offences every year – and despite also the Female Genital Mutilation 2003 Act, when, following the Population, Development and Reproductive Health All-Party Parliamentary Group recommendations on FGM in 2000, the last loophole in the legislation was closed. That initial question is examined in more detail here, in an attempt to understand the wider policy and sociological frameworks of efforts to abolish FGM.

Sadly, we have to face the facts: so far these efforts have had no great success. A decade after the Act, the Summer of 2012 has probably seen several thousand children in or from the UK subjected to FGM; and it is likely that some have died. Yet still there have been no full legal sanctions against anyone in Britain for procuring or performing the horror that is FGM.

Recent public debate about FGM in Britain has however provided some clues about why it persists, and why the UK response has been so disgracefully abysmal. A number of separate threads are emerging.

Misconceptions
There are widespread misconceptions, even wilful ignorance, concerning FGM. We can put aside the ‘it’s only a nick’ brush-off. In a few cases this may be true, but it’s still a red herring.

Far more critically, assumptions thus far about ‘what works’ are often simply wrong:

It is not enough, as one senior politician suggested, that there are Guidelines for professional workers who may encounter FGM. Few of these professionals seem to act upon said guidelines, and they do not seem to be reaching schools.

It is factually wrong to claim, as another MP did, that there is a national co-ordinator for matters concerning FGM. That role was scrapped by the UK Government in early 2011.

It is irrelevant that, as one media editor pointed out whilst choosing not to cover the issue again, there is legislation against FGM. It patently obviously isn’t being enacted.

It is grossly irresponsible ever to suppose as any part of policy that children will self-refer for protection if they are at risk of FGM. Almost all children everywhere defer to their parents, even if they are the initiators or perpetrators of cruelty.

It is unrealistic to suppose that a few thousand pounds in annual grant-aid, spread between competing small organisations (and poorly paid community workers dependent on those funds) will have any impact on this massive issue. Only co-ordinated UK national policy encompassing many services and backed up by sustained, consistent support for local action is likely to be effective.

It is a grave error, sometimes irreversibly costly to the victims of FGM, to confuse education / understanding and prevention / abolition when it comes to stopping this cruel practice in local communities. Euphemisms used by community workers, such as ‘cutting‘, may for instance help clarify what is under discussion, but they do not always reflect the criticality of the UK – or the United Nations and World Health Organisation – position that FGM, regardless of historical cultures, is a grimly serious form of mutilation. The UK legal position is clear: FGM is a crime in Britain regardless of the beliefs or customs of perpetrators, their communities or even local police officers and other safe-guarding workers.

And finally, we are mistaken if we imagine that the UK ‘softly, softly’ approach to FGM – no full prosecutions ever, so far – is the only way. Many African, continental European and other countries take a much more robust view of this crime, inspecting children who it is feared may be at risk or have been harmed, prosecuting perpetrators and sometimes imposing prison sentences on them.

But let us move beyond what (doesn’t) work, to the specific contexts of female genital mutilation.

The MGM-FGM debate
One unexpected aspect of the emergence of FGM into public consciousness, at least for some, has been the element of competition which seems to colour debate about the parallels between male and female ‘circumcision’ (or genital mutilation, depending on perspective). The greatest fury about male, usually infant, circumcision (also by some named male genital mutilation, or MGM) has come from the United States, where the majority of newborn boys undergo it, but there is also a growing consciousness of the issue in Britain and mainland Europe – hence e.g. the recent decision to counter the practice by a court in Germany, and the ensuing heated debate about Jewish and Muslim entitlements to this long-established custom.

To a degree the MGM-FGM debate is off-topic in considering the single objective of stopping FGM, but the so-called ‘What about the MENZ’ issue is always there and thus needs to be acknowledged.

Whilst some seek to keep the MGM-FGM debate on an even keel, the distinctions between levels of risk and legality are not easily encompassed; even a mention of difference can spark strong response in some, whilst acknowledgment of the similarities is dismissed by others. Perhaps, given the very central importance to most adults of their sexuality and sexual functioning, this gender-based contention is to be expected; but it absorbs energy which might otherwise be more focused on the immediate issue.

What is missing here is validated comparative evidence. The epidemiologies of MGM and FGM are factually different. The immediate risk to life of male babies circumcised in controlled and hygienic environments, though not insignificant, is relatively small, whilst the overall risks of FGM to which girls, often older, are exposed are of an entirely different order, both immediately and, assuming survival, later in life (and even her own babies may die because a woman underwent FGM in childhood).

But confirmed and mutually acknowledged details of these relative risks are difficult to obtain. Deaths of older boys undergoing MGM in Africa are sometimes put alongside those (far fewer, though always significant) of boy babies in western countries. Likewise, FGM data is inevitably compromised by the fact that in most places around the globe the practice is illegal and imposed illicitly, plus resulting morbidities and mortalities may be blamed on ‘bad spirits’ – and is therefore also unreliably reported. And still the ancient problem of sand as an irritant in uncircumcised men (and women) is deemed pertinent to some discussions, as currently are the perils of HIV – whilst both may be discussed in the absence of any recognition of the relative degree of risk or indeed of the progress of medical science since these issues were first identified.

And so the vying between some of those who seek to prevent (or promote) MGM and FGM respectively continues, it being unlikely that further and more accurate epidemiological analyses alone could secure completely common ground.

Commonality on MGM and FGM is however a prospect if sought on the basis of human rights issues. The principle that invasive action to change a person’s body should, unless medically necessary, occur only with that person’s mature and informed consent is one starting point. The major complicating factor here however is when proponents of infant male circumcision claim a priori religious entitlement to perform their customary ceremonies – just as, despite the law, do proponents of and apologists for the medically very dangerous procedure of FGM.

In short the MGM-FGM debate is by no means resolved. In a world where the American Pediatric Association has just recently in effect vindicated (for health insurance claims) male infant circumcision, and where Berlin has now declared male circumcision legal in controlled circumstances, the dismay of those – some of them men who sadly feel their whole lives have been affected by a procedure which happened when they were newborn and who refer to ‘circumcision’ as ‘MGM’ – is tangible.

The claims and counter-claims of MGM-FGM in regard to culture, history, religion, self-determination, personal pain and human rights will remain with us; those who wish to pursue this debate are welcome to do so in a separate, dedicated post which can be found here.  But still a girl suffers potentially lethal genital mutilation somewhere in the world every 18 seconds – around 8,000 children every day; and still, averaged out, more than two girls and babies are at risk of FGM every hour of every day even in the UK [see A Statistical Study to Estimate the Prevalence of FGM in England and Wales].

Here indeed is difficult and contested territory where strongly held positions must be acknowledged and respected, but that must not be permitted to detract from halting FGM. There can be absolutely no leeway in stopping FGM .

Health, wealth and welfare
Critical though they are, the immediate health and well-being benefits of preventing FGM, and the uncompromising moral case for this action, are nonetheless not the sole reasons for eradicating this practice.

Uncircumcised girls in the relevant communities are known to continue longer in school (their health is better, and they are not seen as ready only for marriage); and they start their own families later. Their babies, when the time comes, are also at less risk of morbidity or mortality in the neo-natal period: The WHO estimates that an additional 10-20 babies die per 1000 deliveries as a result of FGM.

These facts are compelling.

Currently, scarce medial resources in developing countries, and health care in .e.g. Britain, must be expended in trying to save the lives of girls who have suffered FGM, and on reducing the risks later on to mothers who have been circumcised and their babies. Resources are also required where this is done to reverse (as far as possible) the damage of FGM when girls reach adulthood.

Overall, girls the world over who remain longer in education lead healthier lives, have fewer and healthier children, and are more able to contribute to their nation’s formal economy. Preventing FGM therefore relieves demands on scarce public resources and helps to curtail demographic pressure as the world population continues inexorably to grow.

It is therefore regrettable that in some communities, as parental wealth and education increase, the classic FGM operator is despite widespread disavowal being replaced by trained professionals within the health sector. The role of medical educators is therefore central in presenting the case against FGM and ensuring health practitioners have nothing to do with its delivery.

Whilst full consideration of these matters is for another time, it is notable that factors such as those above – healthy mothers and children, self-determination for women and men alike, reducing population growth – are fundamental aims of global institutions for the common good, such as the United Nations and the World Health Organisation.

Complexities of context
Amongst the complexities directly involved in seeking to the eradicate FGM is the ‘cultural’ question.
Informed commentators have now moved well beyond the claim that FGM is a cultural or religious requirement, and that little could or should be done about it. This position has never been genuinely viable, because FGM involves real physical (and therefore illegal) harm to minors, but it has for some until recently provided a smoke-screen behind which those keen to excuse inaction might hide.

Wider public opinion – which inevitably to a degree informs professional practice on the ground – has not however necessarily caught up with this important shift towards seeing FGM for what it is, i.e. serious child abuse. Almost every discussion of FGM on websites now produces a crop of commentary (some of it verging on racist) to the effect that this abuse is required by Muslims, Christians or others – which are then followed by refutations of this claim, suggesting instead that the issues are not ‘religious’, but, rather, ‘cultural’.

It is certainly true that cultural traditions are evident in the practice of FGM, but more recent thinking points to the practice as being fundamentally about specific matters of identity and shared understanding.
FGM appears to become more common when the identity of a group is perceived to be threatened.

Thus, for example, it is thought that some ex-pats who relocate to European cities may be more attached to FGM than people in the ‘homeland’. To this extent FGM is in the sociological sense a ‘tribal’ marker or identifier, rather than a cultural norm. The challenge in this context is to find other less lethal markers / rites of passage which satisfy the requirements of a strong group identity.

It should also be noted here that, rite of passage or not, the age at which girls undergo FGM seems to be getting younger. This is probably because ‘early’ FGM is considered by parents to be less traumatic for the child; but it is also because pre-schoolers are under less public scrutiny and the procedure is therefore unlikely to be detected by people outside the family.

Nonetheless, in some communities folklore insists that girls (and boys) have to demonstrate strength and bravery to survive ‘circumcision’ before they can be deemed adult; and some even believe, amongst other things, that in the absence of FGM a women will be hyper-sexual (a belief which also characterized Victorian England) or, alternatively, unable to conceive, or a baby will die if in delivery its head touches the mother’s clitoris, as will a man if his penis touches it. There is also sometimes a belief that the clitoris will continue to grow as a ‘third leg’ as if it isn’t removed. Plus, if all that isn’t enough, it must also be remembered that FGM perpetrators make a living from their practice; unless actively persuaded otherwise they will be keen as professional operators to ensure these folklore rationales continue.

Given such beliefs it takes a fiercely brave and independent woman indeed – a woman like Ayaan Hirsi Ali or Waris Dirie or Soraya Mire – to question or challenge FGM. In some communities FGM is simply the norm, a part of ‘what happens’ on the road to female maturity.

Oppression of women
But most fundamentally and generically of all, FGM is, and always has been, a powerful physical and psychological vehicle for the oppression of women by men.

This is a practice which causes great pain and makes sexual response at the very least problematic. It is overtly intended to ensure that women do not engage in pre- or extra-marital sex; and it is perpetrated or procured by (grand-)mothers upon their daughters with the express objective of thereby making them more ‘marriageable’. Obviously, changing this requires active consent and support from men as well as women.

Marriage in traditional societies is an economic rather than a personal, emotional contract. The absence of financial independence ensures that women depend upon their husbands for day-to-day living; hence the persistence in such societies and communities also of other gravely female-oppressive practices such as child and forced marriage, and family ‘honour’ violence. Little wonder that, unless men demonstrate their willingness to abandon FGM – and increasingly some do – mothers actually want their daughters to undergo it. Not being circumcised may result when women are adult in destitution.

Such a situation is difficult for westerners to comprehend. There are few enough women’s refuges in contemporary western cities, but the need for them is understood. There are virtually no such refuges in some other places, nor any demand that there should be. Nor is there always legislation, despite the Universal Declaration of Human Rights, to protect women’s personal safety. In many traditional societies a woman will (in effect) be traded as a chattel from her father to her husband; and she cannot return to sender.

In denial
The facts of FGM are horrendous reading. Not only is it extremely distressing to acknowledge what FGM entails, but this distress is often accompanied by feelings of powerlessness: how can anyone tackle these deeply embedded beliefs and practices about such an intimate issue? Neither modern science nor the western legal system are, it may be thought, adequate to challenge the contexts in which FGM continues to thrive.

And so many UK professionals continue in denial: Surely the figures (around 24,000 children at risk every year in the UK) are wrong? Isn’t FGM just a past-its-sell-by tradition now dying out anyway? In any case, nothing can be done because no-one is willing to come forward…. We put out the literature, and scarcely a soul has come back to us, so it obviously doesn’t happen in our patch. Which is just as well, because quite how difficult would it be if we did have to talk about such things?

The excuses and avoidance tactics perfunctorily adopted by some health professionals, teachers, law enforcement officers and even child safe-keeping practitioners are many and various, but ‘nothing to do with us’, ‘too complicated’ and ‘so embarrassing’ must rate amongst the top let-outs.

I have argued elsewhere, after very careful thought, that FGM can be, and often has the potential to be, a crime equivalent in its impact to the eventually lethal abuse of Baby Peter… a tragedy which quite rightly resulted in massive national media coverage and major fact-finding enquiries, as well as the dismissal of social workers.

Yet whilst the statistics tell us that children and babies die as a result of FGM on a regular basis, there has not to date even been a full legal sanction imposed on any British perpetrator (though a few people have recently been arrested as suspects) – let alone adequate formal, public action to procure the careful professional attention of child safe-keeping practitioners to the dangers of FGM.

Indeed, when an HM Government e-petition [see here for original version] to STOP FGM in Britain [eventually published version here] was first presented in May 2012, it was rejected, probably because the wording included the phrase ‘professional neglect’, which may have been seen by the powers-that-be as ‘problematic, as it is potentially accusing unnamed individuals of criminal activity and could be seen as defamatory’… a strange reservation, given that there was no reference to individuals, whilst the total number of ‘unnamed’ professionals with a responsibility for child safe-keeping in the UK must run into tens of thousands or more.

Such studious regard for the sensitivities of UK professionals is, moreover, not a noted aspect of professional sanction in all instances of child safe-keeping which do not involve FGM. It is therefore tempting to see this reluctance to publish the STOP FGM e-petition as being about the squeamishness and lack of focus we note above.

Analysis and action are needed, now
Whatever, there can be no further excuses for inaction on FGM in the UK. Every day of delay is another day during which small girls will be subject to mutilation and permanent damage. This very week there will be children returning to school after their ‘holiday’ who somehow seem different, who are withdrawn and perhaps stressed and in pain and who, like their counterparts back ‘home’ who tend to abandon education after FGM, have become fearful and inattentive to their studies.

The one positive outcome of the emerging scandal of FGM in Britain is that national consciousness of the issues has been raised. The published Guidelines plus a few seminars are a feeble response indeed to the challenge of this awful child abuse; but they are a small start; and a reinstatement of the role of national co-ordinator for FGM would be an indicator that the Government has recognised the necessity to move beyond rhetoric and exhortation, to real support of professionals and community activists who must address the issues on a daily basis.

In the meantime, girls in FGM communities abroad, and young people in some of Britain’s vulnerable communities are beginning to make the campaign against FGM their own; and many more of us are demanding a serious and co-ordinated national effort to bring FGM in the UK to an end.

Despite the apparent reluctance and squeamishness of some who have a responsibility to safe-guard children, this is not in the end about blaming the professionals. It is about facing up to the complexities of a horrible, complex and ancient custom which fits nowhere in the modern world.

Part of that reality is the effective delivery of the law as it stands in the UK. But another part is acknowledgement of the anthropological and sociological underpinnings of FGM, shifting sands in different communities though these underpinnings may be.

Recognition of these underpinnings requires, fundamentally, that, wherever on the planet they live, mainstream society respects and values women and men equally. It is not enough to demand that certain traditional communities shift from a view of women as chattels to one which sees them as independent, self-determining people. Significant socio-economic and policy improvements in parts of contemporary western society will also be required, if this message is to have any longer-term impact.

Delivering real change to STOP FGM
In the shorter-term however equipping professionals – medics, teachers, legal people, social workers – to do their jobs properly is essential. It is for the courts, not the media, to decide who is or is not guilty, and what sanctions are appropriate for those who have committed the crime of procuring or inflicting FGM on children. But formal and heavyweight legal action against the perpetrators and practitioners of FGM in Britain must be delayed no longer.

Alongside formal action to demonstrate irrevocably that FGM must stop in the UK, there is nonetheless a need to understand and explain more. Workers within vulnerable communities must accept that, whatever they choose to call it, their first duty is to emphasise that female genital mutilation is a very serious crime.

But these workers also need support in helping to move their communities to different understandings of their host society, a society in which women and men alike have individual rights to education and personal self-determination and entitlements to a life free from intimidation, and in which scientific knowledge of how our bodies work has replaced deeply damaging folklore.

The most important action which we can all take however is to keep up the pressure. There are a number of petitions to STOP FGM which can be signed and shared, including this one specifically for UK citizens and residents on the HM Government e-petition website: STOP Female Genital Mutilation (FGM / ‘cutting’) in Britain

Additionally updates, usually daily, on FGM matters can be followed on Twitter [@NoFGM1], and information about organisations and developments can be found here [#NoFGM: A Listing For Action & References On Female Genital Mutilation], which is a webpost where we also encourage others to share their actions and observations. This Listing also provides information on other web locations to learn more and to become involved.

Above all, however, there is the need to keep this issue in the public eye. Thought leaders, men and women in health, public policy, community development, politics, education, religion and the law all have a vital role to play here. We need them to speak out against FGM loudly, clearly and repeatedly. The impact of a few very high-profile (male?) religious leaders or media personalities for instance could be great.

Letters from the general public urging action to MPs and newspapers, phone-ins to radio stations, invitations to friends and colleagues to sign the ‘#NoFGM’ petitions (above), questions asked in schools, local councils, health consultations and professional meetings are also needed; all will also help to ensure that FGM is better understood and not forgotten.

In the end, it is the growing realisation everywhere that FGM must stop which will actually make that happen. There must be no more summer holidays which tragically for some are about pain, not fun.

~~~~~~

This paper is a more detailed version of a post with the same title published on 16 September 2012 by the Huffington Post.

More information and links about FGM are available here. (See also Facebook: NoFGM (UK), Twitter: #NoFGM and @NoFGM1.)

Please sign the HM Government e-petition to STOP Female Genital Mutilation (FGM / ‘cutting’) in Britain, and ask everyone else to do the same. Thank you.