Female Genital Mutilation

Baroness Finlay of Llandaff Excerpts

Thursday 9th June 2016 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I congratulate my noble friend Lord Berkeley of Knighton on having secured this debate and the timely nature of it given that we are coming up to the summer holidays, when prevention must be a critical aspect of the way that we behave towards young girls who are at risk. We know, as has already been said, that the estimates are that between 60,000 and 65,000 young girls under the age of 17 are at risk in the UK. At the outset, I give credit to two junior doctors, Dr Erna Bayar and Dr Jessica Gubbin, who are trying to investigate the level of knowledge among healthcare workers here in London. They are both junior doctors at St Mary’s, and they are here to listen to the debate today.

With regard to the report from the House of Commons and the figure of 137,000 victims in the UK, which has already been alluded to, it is worrying to note that only one-third of the cases referred to the Metropolitan Police—although there were no prosecutions—came from health and education. The Serious Crime Act 2015 has already been referred to, but it is worth noting that there seems to be enormous ignorance about the Act itself and the extraterritorial offences, as well as exactly what the duty of care is—in particular, the offence of failing to protect a girl from the risk of FGM.

A study from Birmingham, conducted through members of the Royal College of Obstetricians and Gynaecologists, was the first UK-wide survey of its nature. It revealed that one-fifth of respondents were not aware of the FGM Act, although over 93% knew that it was illegal in the UK—but there is a difference between it being illegal in the UK and the extraterritorial offence created in the Serious Crime Act. Appallingly, fewer than 10% of respondents were aware of the psychiatric morbidity in the victims of FGM. There did not seem to be any difference in the knowledge scores among different grades of staff, but it was worrying to read that there were lower knowledge scores overall among those who had been in obstetrics and gynaecology for more than 15 years. In other words, the younger generation had a greater level of awareness than the older generation, although it does not seem to feature in the curricula of all medical schools, which I suggest that it should.

In 2010, the Royal College of Midwives published a report in which it found that 70% of midwives were aware of UK law and one-fifth stated that it was illegal to resuture after birth, but there was little knowledge of where to refer a victim to, and only 15% of midwives reported having any training. To date, I have not been able to find a survey of paediatricians. There needs to be education across all levels, in medicine, nursing, midwifery, social work, physiotherapy and so on. There are some very useful educational tools out there. Health Education England has produced one, and there are e-learning modules that healthcare professionals can sign up to. But there seems to be an ignorance about how to report within a trust, whether to go to the police, and exactly where the interface is with safeguarding and domestic violence.

The worrying figure from the literature is the large number who do not even know how to ask about FGM, do not know what to look for, do not know how to document it, and certainly do not know the complexities of the law. However, we are looking at children under the age of 17, in general, as victims, and we know that over 80% come from the populations of Somalia, Eritrea, Ethiopia, Yemen, Sierra Leone, Egypt, Mali and Sudan, even though, in some of those countries, FGM is deemed to be illegal. There is good WHO guidance out there, but it is not being accessed, and it was worrying to find a study of a small number of UK victims suggesting that, of 27 victims who had been mutilated to a varying degree, the majority of them severely, for 71% it had happened in some kind of medical setting, where it had actually been performed by a doctor.

Teachers in primary schools—and in secondary schools particularly teachers of the lower age groups—have spoken about recognising girls who come back after the summer holiday who are completely different to the lively, bright and happy child who they saw before the summer holiday started. They are pretty sure that these girls have been taken away. They are never the same again. They remain inhibited, depressed and mistrustful within the class. These are girls who will have been at risk.

Much has already been said about obstetrics, and in a previous debate I have spoken about some of the obstetric disasters that can happen to these women. They are at risk of HIV and hepatitis B as well as of pelvic infections and so on. There is another pointer that is often missed, and that is where girls fail to attend GP appointments and when mothers fail to take their daughters along for routine checks, even when they are babies. This failure to engage with the NHS and the general practice system seems to be linked to later becoming victims of FGM.

It is about time that the Government changed gear on this. I know there have been a lot of campaigns to raise awareness, that there are so-called cultural sensitivities around this and that there is a fear of being branded somehow racist or discriminatory. However, these are children, and this is child abuse. It is abhorrent, and we have a duty to protect the victims. We have those who are already victims, but we have to protect the victims of the future. Have the Government considered using Section 75 of the Serious Crime Act to produce further statutory guidance before the summer holidays to go to schools to require them to engage with the parents of children who are in the at-risk population, to open up the subject and the discussion and let it be known that this is an offence here and extraterritorially? There is a duty of care that rests on teachers as well as on healthcare professionals. That must be done before the summer holidays, otherwise we will have another cohort of girls who have been terribly damaged by this deeply abhorrent practice.