Engaging with communities to prevent female genital mutilation

Social workers and health professionals are working together in Bristol to convince communities that female genital mutilation is abuse, reports Louise Hunt

Jackie Mathers (pic: Tim Gander)

Social workers and health professionals are working together in Bristol to convince communities that female genital mutilation is abuse, reports Louise Hunt


● Project name: Female Genital Mutilation (FGM) safeguarding group (a subgroup of the Bristol Safeguarding Children Board).

● Aims and objectives: To ensure FGM awareness is embedded in all professionals’ training; to empower young people and women in communities where FGM is practised.

● Numbers of service users: 80-100 women and girls have been active in awareness-raising work so far.

Cost of project: a £30-40,000 contract with Forward for outreach work with community groups, including staff training.

Outcomes: An increase in referrals of FGM cases, more openness with community groups and stronger multi-agency working.

In September last year BBC Radio 4’s Woman’s Hour aired a drama documentary on female genital mutilation (FGM) written by a group of Bristol teenage girls who had been affected. In it they made the point that, if white girls were being forced to have their external female genitalia removed, the practice would have been tackled on a wider scale. But, because it is viewed as a cultural issue, the approach is more muted.

Yet the docudrama points to Bristol’s ­success in this area, highlighting the strategy of bringing on board communities that practise FGM and helping to empower the women to view it as child abuse.

Jackie Mathers, NHS Bristol designated nurse for safeguarding children, has been co-ordinating the development of the city’s FGM prevention strategy. She says part of it was to ensure multi-agency professionals also understood that message.

“The issue first came to my attention in 2006,” she recalls, “when a school nurse, who had attended training on preventing FGM, went back to the school and was shocked when parents said ‘yes, of course my child has been cut’. We realised we had no guidance on how to prevent it and it was difficult to know how to address the issue.”

Although the practice is illegal in the UK, it is a cultural practice in about 30 countries mainly in Africa, but also some in Asia and South America. About 6,500 girls are at risk of FGM in the UK every year, according to campaign group Forward. FGM carries the risk of long-term consequences, including infections, complications in pregnancy and child birth and psychological damage.

In Bristol, where it is estimated that up to 2,000 girls are at risk, Mathers drew together representatives from health, social care and education on a subgroup to develop guidelines for the city’s Safeguarding Children Board to identify and prevent FGM. Since 2007 there has been a programme of awareness-raising and training for practitioners who work with children.

“Our guidelines make it clear that if a practitioner is aware of an FGM victim they should make a child protection referral,” says Mathers. “Sometimes the case can be closed by getting an agreement from the family that they will get medical attention for the child and won’t continue the practice with siblings, but in some cases it is necessary to make a child protection referral.”

Mathers is also talking to social work students at the University of the West of England. “We go through the Every Child Matters outcomes to bring into focus that this is about the child’s choice, and that people can have their culture but not at the expense of child protection.”

Having reinforced the message among professionals, the programme of work is now focusing on engaging more with communities where FGM is practised. Mathers points out that the BBC radio docudrama is an example that “it is not just professionals that are identifying the problem, communities are also calling for help”.

Zero tolerance

Bristol SCB and Bristol NHS, with the help of Forward, (the Foundation for Women’s Health Research and Development) are now running a series of “zero tolerance” events. The third, on 15 February, attracted 65 people, mostly from FGM-practising communities. The aim is to encourage people to become advocates and spread the word. This year the team has also formed men’s groups and young people’s groups and is hoping to make in-roads with so far hard-to-engage religious leaders.

It’s an area in which Mathers believes social workers could be more involved: “We would like them to be more visible in the community to demystify negative connotations around what social workers do.”

Anne Farmer, Bristol children’s services area manager, believes the awareness training and multi-agency approach has given social workers more confidence in recognising and intervening in FGM cases transparently. “It has also improved our relationships with schools, health and the police – we have a lot more informal discussions now – which is fundamental to tackling FGM,” she says.

Nationally, Mathers does not believe every area has the same level of awareness as Bristol now has, with the exception of London, although this may change with the release this month of the government’s multi-agency guidelines on preventing FGM.

The approach has clearly made a difference in Bristol. “We have evidence that referrals have increased after the development of the guidelines,” says Mathers. “This year there have been about 18 referrals concerning FGM, whereas previously they were not recorded. Although it is an increase in workload for social workers, the communities know we are taking the issue seriously. So although the girls we pick up may have already suffered FGM, now their siblings might not.”

School takes firm stand and keeps parents onside

Claire Smith, head teacher at St Werburgh’s Primary in Bristol, decided the school should take a proactive but sensitive approach to preventing female genital mutilation.

“We needed to be clear on the law but did not want to alienate communities,” she says. “If you say you are having a meeting about FGM then no one will come, so we worked with structures already in place to engage communities.”

Using data on when FGM practices were most likely to be carried out on children – those aged between four and 11 and often during the summer holidays because children have to be off school for several weeks afterwards – Smith began raising the issue with parents who applied for extended holidays for their children.

Working with the school nurse, who had undertaken training in FGM awareness, Smith developed a protocol on how to approach the topic in a respectful and inclusive manner.

The opportunity for more direct engagement came when a group of Somali mothers wanted to be more involved with the school and other aspects of UK life. FGM was broached during a talk on African health issues as part of a series of workshops on living in the UK run by the school.

“Most of the discussions were in Somali with an interpreter,” Smith says. “At the end, the women were asking how they could stop this happening to other children. They were very helpful in guiding us on what is OK to say, and put together phrases that make it clear that the practice is illegal in the UK. They also said they would spread the word discretely in the community.

“It was a really emotional event,” Smith says. “They had all been cut themselves and were under pressure to get their daughters cut. It started off being about information giving, but became very empowering for them.”

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Title: Reference Manual: Female genital mutilation

Author: Dr Comfort Momoh, FGM/public health specialist, African Well Woman Clinic, Guy’s and St Thomas’ Hospital

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