Culture and cruelty

Despite being outlawed in 1985, the practice of cutting or
removing parts of young girls’ genitals has not been eradicated in
the UK. Adwoa Kwateng-Kluvitse, acting director of Forward, a
London-based non-government organisation working internationally to
eradicate female genital mutilation (FGM) and other gender-based
violence, says there is evidence that it is being carried out here
by refugees who are excisors, doctors, midwives or traditional
birth attendants.

Sarah McCulloch, national director of the Agency for Culture and
Change Management, says that refugees from Somalia and other
countries in the Horn of Africa still practice infibulation, the
most extreme form of FGM, involving cutting off the entire external
genitalia and stitching up the vagina leaving just a tiny opening.
She says: “People have done it for generations. They are still
doing it.” Although there is a move towards medicalisation, where
it is performed by trained staff under sterile conditions, it may
be carried out in non-sterile conditions using knives and razor
blades without anaesthetic.

From a Western perspective, FGM is hard to comprehend. However, in
practising communities it is not seen as child abuse but as a
religious or cultural requirement or a rite of passage.
Kwateng-Kluvitse explains: “The child is a loved child and families
do it because it’s a cultural tradition. Other communities believe
it is a religious obligation. Often the language used puts it in a
religious context. People use expressions like ‘sunna’ which means
an obligation of the prophet, or ‘halal’ or ‘haram’ which
translates as ritually pure or impure.”

She points out that for migrants and refugees fleeing war and
persecution, adhering to traditional practices may be particularly
important: “People need to identify with home and so they cling to
these practices.”

Because FGM is not talked about openly in practising communities,
women who have undergone it accept it without question and assume
that it is done to all girls. Fadema Hussein, a Somali doctor who
sees many women with health problems arising from genital
mutilation in her clinic in east London, explains: “Even in my
community people don’t talk about it. Culturally a girl won’t
expose herself [to be examined by a doctor] unless there is a very
severe problem.” Although girls experience a variety of
complications from pain and difficulty passing urine and problems
with their periods to kidney infections and back pain, they rarely
make the connection with FGM. They are told by female relatives
that the pain is normal.

McCulloch has been working in Sheffield since 1997 to change
cultural attitudes to FGM. As an African from a community that does
not practise FGM, she was unprepared for the abuse and intimidation
that her work would engender. “I was very naive to think I could
just go into the community and raise awareness and educate people
that this is a human rights abuse and had no health benefits. But
women would go into shock. They have a multitude of health problems
but they assume that everyone is circumcised because it’s not
discussed. There is so much anger and abuse. People feel we are
betraying them.” Currently, a Somali family worker at the project
is under police protection.

Despite the hostility, the agency has been successful in changing
the attitudes of younger people. “People started saying ‘it’s not
really religion, we are just harming ourselves’. Now they are
talking about it more openly. Younger parents feel they don’t want
to infibulate and do the clitoridectomy instead [see panel]. They
are still holding onto something but there is a change in
attitude.”

However, any form of FGM is illegal and opposed by the World Health
Organisation and groups such as Forward, because it violates the
human rights of girls. Despite a change of attitude among younger
people who have lived for some time in Britain, new refugees are
continually arriving. And older people tend to have entrenched
attitudes. Kwateng-Kluvitse says that young women often feel
powerless to prevent their children from being mutilated. “It is
not necessarily the choice of the parents. A young bride living
with her mother-in-law may have the decision taken out of her
hands. It is considered disrespectful if you don’t do what your
mother-in-law says.”

It is impossible to say how many cases of illegal FGM there are in
the UK, because unless a child makes a disclosure which is passed
to social services and child protection procedures are implemented
it may never come to light. Under Working Together guidelines FGM
is specifically identified as child abuse requiring the instigation
of child protection procedures.

Forward has been consulted in three child protection cases during
the past 12 months. Kwateng-Kluvitse explains that the emphasis is
on drawing up a child protection plan that puts in place boundaries
to protect the child and on working in partnership with the family.
“The child would be monitored by a social worker, health visitor,
teacher or nursery worker and maybe by a community group
campaigning against FGM.” She adds: “We highlight the health and
human rights implications for the child and point out that
traditions change. Dropping one practice doesn’t mean abandoning
your culture.”

At the moment, parents are able to circumvent the law by taking
their daughters overseas. Ann Clwyd MP intends to introduce a
private member’s bill in the spring to make it an offence to take a
child abroad for the procurement of FGM. Campaigners believe it is
not unusual for children to be taken to Africa or the Middle East
during the summer holidays. Cases may come to light if a teacher
notices a change in a child’s behaviour – even the mildest forms of
FGM commonly result in infection and urinary problems, or in the
child being withdrawn or traumatised, especially where it is
carried out in unsterile conditions without anaesthetic.

Although she would like to see prosecutions of FGM practitioners
and parents as have occurred in France and a number of African
countries, McCulloch believes new legislation will be most
effective if area child protection committees use it proactively.
In July last year the Sheffield area child protection committee
wrote an open letter to all Somali parents informing them of the
health problems associated with FGM and advising them that if they
were planning to take their children on holiday for FGM they should
reconsider.

McCulloch says: “It caused a furore. People were so angry and said
we were attacking their culture. But the feedback was that people
were afraid and some families cancelled their trip.” 

Facts about FGM

 The World Health Organisation estimates that about 100 to 132
million girls and women worldwide are affected by FGM. Each year a
further two million girls are at risk. FGM is practiced in 28
African countries and is also performed in parts of the Middle
East, Far East and among African immigrants in Europe.

Types of mutilation range from the removal of the hood of the
clitoris (type 1) to infibulation (type 3), entailing the removal
of the entire clitoris, labia minora and labia majora and stitching
and narrowing of the vaginal opening. The most common form of FGM,
clitoridectomy or excision (type 2), involves removal of the
clitoris and all or part of the labia minora and accounts for 80
per cent of all mutilations.

It is estimated that between 20,000 and 25,000 girls in the UK
under the age of 16 may be at risk of FGM. Although specifically
outlawed in 1985 there is anecdotal evidence that it is still
widely practised in some communities. In a recent study of Somalis,
Ethiopians, Sudanese and Eritreans living in two west London
boroughs, more than 80 per cent of women interviewed had undergone
FGM.

The short-term heath implications of FGM range from severe pain and
shock to infection, injury to other tissues and fatal
haemorrhaging. Possible long-term effects include complications in
pregnancy and childbirth, psychological problems and extensive
damage to reproductive and urinary systems.