Female Genital Mutilation

Debate between Lyn Brown and Bob Stewart

Monday 10th March 2014 Westminster Hall

[Lyn Brown (West Ham) (Lab)]

I want first to congratulate my right hon. Friend the Member for Leicester East (Keith Vaz) and the hon. Member for Mid Derbyshire (Pauline Latham) on securing the debate and to welcome the comments made by the Secretary of State for International Development over the weekend. Both sides of the House will unite on female genital mutilation to ensure that we prosecute those responsible for inflicting such a brutal practice on girls and women, and that we eliminate it once and for all.

Shockingly, an NSPCC survey of teachers reported that one in six are unaware that female genital mutilation is a crime, and that 68% of teachers are unaware of any Government guidance on what to do if they believe that a girl whom they teach is at risk. It is clear from what we have heard over the past weeks and months that we need to increase awareness of the practice among all professionals, such as GPs, midwives, teachers and health care and social workers. To do so, however, we must be more open as a society about discussing women’s bodies and be more comfortable with the language. Open and honest dialogue with boys, girls, men and women about women’s bodies will help to raise awareness and to break down the barriers that cause ignorance and embarrassment. We need to use words such as vagina and clitoris, because the more that we say them, the more comfortable we will become with initiating and engaging in such discussions.

Some hon. Members present will recall that I spoke in the Chamber during the Adjournment debate before Christmas about a procedure called a hysteroscopy, which looks inside a woman’s uterus and is often used to investigate symptoms such as pelvic pain, abnormal bleeding and infertility. I must admit that I found it difficult to use words such vagina, uterus and cervix in the Chamber.

[Bob Stewart]

You did it very well.

[Lorely Burt]

Well done.

--- Later in debate ---

[Bob Stewart]

I thank the hon. Lady for her speech. I was there when she spoke in the Chamber and thought that she did tremendously well. Is the unit to which the hon. Lady refers able to visit schools in her constituency to educate both teachers and children to try to stop this abhorrent crime?

[Lyn Brown]

The unit is in its infancy and is currently developing how it will work within the community. I will go on to discuss what the unit expects to do in the next bit of my speech.

When a maternity professional becomes aware of a mother who has been the victim of genital mutilation, they are required to make a referral to safeguarding officials for child protection reasons and to invite the woman to access the genital mutilation prevention service. The service is geared up to support the victims of female genital mutilation to empower them to understand the negative consequences of mutilation and to enable them to become an advocate against the female genital mutilation of their own daughters. The service will provide advocacy for victims, involving extended family and spouses where appropriate, and thereby support women in their own environment to take a stand against the practice.

In answer to the hon. Gentleman’s question, Newham council is training community-based female genital mutilation champions and is supporting victims to report domestic sexual violence to the police. So it is working with women in the community to work with women in the community in order to raise awareness of the act’s illegality.

Holocaust Memorial Day

Debate between Lyn Brown and Bob Stewart

Thursday 23rd January 2014 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

It is an absolute privilege to participate in this debate. I wholeheartedly congratulate the right hon. Member for North East Bedfordshire (Alistair Burt) not only on securing the debate, but on his deeply moving contribution.

Members on both sides of the Chamber have made some incredibly powerful contributions reflecting on the events of decades ago and pondering their relevance today—and I certainly believe that they are relevant today. We said then that never again would the world stand by while a state killed its own citizens in such a planned and systematic way. Today, and even then, it was unimaginable—completely and utterly incomprehensible —that a state could inflict such suffering and despair by exterminating its own people and those of other countries simply on the basis of a perceived difference.

Yet, as we reflect on the holocaust, how can we not also consider, as has been said, Cambodia, Bosnia, Rwanda and Darfur, where we have seen communities systematically dehumanised and killed because of a perceived difference, whether it be one of race, religion, ethnicity or belief?

[Bob Stewart]

Will the hon. Lady give way?

[Lyn Brown]

Can I not?

[Bob Stewart]

Of course.

[Lyn Brown]

With the help of the Commons Library, I have looked at some of this place’s wartime debates about the holocaust. They make it absolutely clear that there was a high level of awareness of the situation. In a debate on refugees on 19 May 1943, a Home Office Minister said that since the outbreak of the war, 8 million people in Poland had suffered barbarous punishment or death, and many others spoke knowingly of the Nazis’ intention to exterminate the Jewish people.

There is also a palpable sense in these pages of powerlessness with regard to tackling the problems, which were known about, and saving lives. Perhaps that sense of powerlessness has been echoed in this Chamber throughout the decades since. Indeed, I remember the debate on Syria.

In 1939 the merchant ship St Louis set sail from Hamburg with 937 German-Jewish refugees on board, seeking asylum from Nazi persecution. Despite setting off with visas to allow them into Cuba, they were denied access. They set sail for the US and Canada, where access was also denied to them. The St Louis returned to Europe, and at that point the UK agreed to take 288 of the passengers. Others went to Belgium, France and the Netherlands, but following the German invasion of those territories, they were again at risk, and historians estimate that 227 of the asylum seekers on that boat subsequently perished in the holocaust.

What makes the holocaust stand out is not only the sheer number of victims, but the concrete evidence of how the killing was organised and implemented on such a scale. Of great significance is the fact that every Jew was defined not by their religion or their own definition, but by the perpetrators’ definition. Jews were singled out and registered on a central database—its purpose was to expedite their murder—before being publicly marked, stripped of their citizenship, forced to hand over their possessions, dehumanised and, ultimately, deported to their death. I am astonished that the Nazis intended to expand the final solution beyond their borders: they drew up lists of Jews in the USA, Great Britain, Israel and so on. There has never before been such an event in history.

Our political forebears in this place did something, but we have to admit that it was not enough. Debates at that time referred to quotas or the numbers that should come here or go elsewhere in our empire. I am sure the Government of the day thought they were acting for the best, but it simply was not enough. Edmund Burke is attributed with saying that the only thing necessary for the triumph of evil is for good men—and, indeed, women—to do nothing. We said, “Never again,” and we set up the United Nations to promote world peace, but we have still seen enormous inhumanities unfold in front of our eyes. Even today, we see credible evidence of the organised murder on a horrendous scale of the people of Syria by the state.

In preparing for this speech, I was reminded of one by my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) in 2008. In it, he reflected on a visit to a museum in Rwanda that commemorates the millions who lost their lives as the world looked the other way. There is a picture of a young boy called David, a 10-year-old who was tortured to death. His last words were, “Don’t worry—the United Nations will come for us”. But, as my right hon. Friend said, we never did. That child believed the best of us, only to discover that the pieties repeated so often, over and over, in reality meant nothing at all. The words “Never again” became a slogan, rather than what they should be—the crucible in which all our values sit and are tested.

My mother, like many of her generation, watched the liberation of the camps on newsreel footage. She was so profoundly moved by what she saw that she ensured that I was educated about it, and she gave me a copy of Anne Frank’s diary when I was about 10 years old. I devoured that book—trying to imagine myself in Anne Frank’s shoes—and I gained a tiny insight into the injustice and inhumanity to which she and her family were subjected. It was a lesson that I hope I have not forgotten. Years later, my mother and I visited Prague. We went to the ghetto, and saw the walls with the names of the 80,000 Jewish victims and the piteous paintings by the children.

I hope that hon. Members will allow me to say that I am neither a moral nor a political coward, but I know myself: I know how that visit, and the ones to Anne Frank’s house and to Dachau, affected me. I have therefore baulked at making the trip referred to by many hon. Members today, but in the light of this debate, I will face up to the challenge and visit Auschwitz-Birkenau before the end of this Parliament with, I hope, the support of the Holocaust Educational Trust.

This year, we mark the centenary of the outbreak of the first world war—the great war, as it was labelled at the time—and we should use the tone of this debate, which I commend, to fend off the revisionism that such occasions sometimes engender. It is widely believed that the treaty of Versailles created the conditions in which fascism emerged into the 1930s, and from which the horrors of the holocaust unfolded. Let us bear that in mind when we assess the events of 100 years ago and let us apply the lessons to our foreign policy when we encounter inhumanity in today’s world.

We know so much about the holocaust. We should be immensely grateful to the Holocaust Educational Trust for providing the resource that we all need. I join others in commending its work and that of Karen Pollock in particular. I am sure that the trust will rise to the challenge of keeping alive and accessible the stories and lessons of the holocaust as the number of survivors sadly dwindles over time. I commend the Government’s continuing commitment to ensuring that the holocaust is never forgotten, including through their funding for the Holocaust Memorial Day Trust under the admirable leadership of Olivia Marks-Woldman. Both trusts play their part in humanising the holocaust. In my view, that is the only way in which we can begin to comprehend such a vast and enduring tragedy.

In the Chamber today, we have heard how Members have comprehended the horror through seeing the piles of shoes or treading the steps into death chambers. For me, it is those paintings by the children in the Prague ghetto. We know so much, and yet we seem to learn so little. As we pause in the week before we mark Holocaust memorial day on 27 January, with its theme of journeys, we should take time to reflect on our global shortcomings and on our tendency to recognise the absolute horror of the holocaust, and yet to allow subsequent genocides to happen with such depressing frequency.

Christmas Adjournment

Debate between Lyn Brown and Bob Stewart

Thursday 19th December 2013 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

It is an honour to follow the hon. Member for Stafford (Jeremy Lefroy), who has entertained us with a very thoughtful speech this afternoon. I am going to follow up the health theme, but my discussion of it is going to be a little more graphic. If any hon. Ladies or hon. Gentlemen wish to leave, I shall not take it as a personal affront. They might find it more comfortable to go off and get a cup of tea.

I want to talk about hysteroscopy, particularly when undertaken without anaesthetic. This topic was brought to my attention by my constituent, Debbie, who lives in Plaistow. She was diagnosed with womb cancer or uterine cancer last year. She contacted me because the process of diagnosis, rather than the cancer itself, caused her

“the most distressing and painful experience”

of her life. Debbie underwent a procedure called hysteroscopy, which looks inside a patient’s uterus and is used to investigate symptoms such as pelvic pain, abnormal bleeding and infertility. Biopsies are often taken and tissue is often removed. The patient’s vagina is opened with a speculum, as during a cervical smear test, and a hysteroscope is inserted. A hysteroscope is a thin tube with a light and camera on the end, as well as any other instruments that might be needed. As I am sure I need hardly point out, this procedure is highly uncomfortable and clearly has the potential to be very painful indeed.

At present, the NHS Choices website explains

“a hysteroscopy should not hurt, but women may want to take a pain killer such as ibuprofen beforehand”.

As well as a hysteroscopy being an out-patient procedure, the NHS website says that

“the procedure can also be carried out under general anaesthetic, which may be recommended if your surgeon expects to do extensive treatment at the same time or if you request it.”

So far, this sounds fairly reasonable: it will not necessarily be pleasant, but there are options and the procedure can be carried out with or without pain relief and with or without local or general anaesthetic.

Let me tell Debbie’s story in more detail. Through Debbie, I have also heard stories from other women across the country. Debbie told me:

“I was in absolute agony. The consultant who performed my procedure knew I was in pain but carried on regardless. A nurse had to push me back down on the bed as I stiffened like a board. She had to hold me there and had hold of my hands too as I was trying to reach down and stop the procedure. All I could think was that if I made the consultant stop, I would have to come back and endure the whole thing again. This procedure, without anaesthesia, is barbaric. It is absolute torture. It needs to be stopped. At the very least, the patient should be informed that it could be extremely painful and have options explained and open for her. That way, she can make an informed decision as to whether to go ahead without anaesthesia.”

[Bob Stewart]

That sounds absolutely horrific. The hon. Lady did not explain whether Debbie was asked whether she would like a general anaesthetic. I presume that she was not asked and that the procedure went ahead without it.

[Lyn Brown]

Her very next sentence explains that:

“I was given no options. I have complained to the PALS department and to be quite honest I am not happy with their reply. At one point it mentions that the hospital gets more money for the procedure to be done as an outpatient! Is this what it boils down to? Money? Disgusting!”

Jan from Cheshire said:

“I had a hysteroscopy in Cheshire. This hospital is a private hospital but I was there as an NHS patient, as it was the hospital that my doctor could get me into the quickest, for investigations into abnormal bleeding. I saw the consultant in September of 2011, and was given an evening appointment to attend for a hysteroscopy, and was told that the procedure would be done under local anaesthetic. At the evening appointment, I was given a local anaesthetic, but after several attempts at performing the hysteroscopy, the consultant apologised and said that she was unable to perform the procedure and did not want to attempt it again under a local anaesthetic as, in her words, ‘it would be inhumane to continue under a local’. I was sent home and told to take co-codamol for pain relief, and that I was to return the next day for the procedure to be done under a general anaesthetic. I have got to say that even though I had a local anaesthetic”—

if Members have been paying attention, they will know that my constituent Debbie was not offered that—

“the procedure was still very uncomfortable and painful. I have to say that I think offering a hysteroscopy without any form of anaesthetic is barbaric.”

Jo from Chesterfield said:

“I had already had biopsies done in clinic with no anaesthetic, done like a smear with swabs but going through the cervix. I had found this painful but nothing prepared me for what was to come. I had been given a leaflet to outline the procedure but it mentioned nothing about pain or discomfort. I was asked to go behind a make-shift cubicle in the corner, take everything off and put on a gown. I was then asked to sit in a contraption that looked like some Victorian birthing chair, it was very uncomfortable and awkward to sit in. I felt so undignified…I have never felt such pain. I felt like my whole abdomen had been blown up, the pressure was so intense, then sharp prodding pains, I had tears in my eyes, the nurse did come and hold my hand. I just looked at the ceiling and held my breath, praying for it to be over.

When he’d done, the doctor asked ‘did you find that a bit painful?’. I replied ‘no it was excruciating’, he just remarked that most women are fine with it but perhaps I had a low pain threshold and that if I were to need further treatment I would need a General Anaesthetic as I was sensitive. I was quite gob smacked and in so much pain I didn’t really reply. I struggled to my car and drove home, I was in agony for days. I felt almost like I’d been violated, like a piece of meat, but thought perhaps it was just me, perhaps I was being a wuss. It wasn’t till I spoke to other ladies that I discovered it needn’t have been this way. My treatment on a whole I feel was done very wrongly, cutting corners and saving money, at my expense. The hysteroscopy should not have been done this way, it’s almost inhumane.”

Katharine from Bath said:

“My GP referred me for day-case hysteroscopy under local anaesthetic…He told me to pay for a course of Cognitive Behavioural Therapy to lower my Blood Pressure to qualify me for NHS day-care surgery as opposed to more expensive NHS inpatient surgery. During the Cognitive Behavioural Therapy the psychologist told me to go straight to the gynae-oncology surgeon at the hospital and have my persistent inter-menstrual bleeding properly investigated. My GP was furious at this suggestion but eventually gave in. The gynae-oncology surgeon told me that ‘you’ve had it for so long it won’t be anything sinister’. He eventually agreed to an inpatient hysteroscopy under General anaesthetic. I waited months for the operation. It showed late stage womb cancer which had spread to the lymph nodes. I had a radical hysterectomy and a long course of external radiotherapy”.

Jenny from Barnsley said:

“I went into the clinic and was given an ultrasound and very quickly was approached by a senior registrar who said I had a very thick womb but they could do a biopsy there and then.

My GP had mentioned that this procedure can be difficult but they would give me a local anaesthetic.

To be honest I was in such shock. I was led into a room where there was a very nice sister and nurse. I sat in a chair and the senior registrar began by filling my womb with water.

Then the hell began when they inserted whatever and did the biopsy. I have not experienced such pain even in childbirth and I told her so. I also said my GP had said they would give me some local anaesthetic and then she asked if I wanted some. Rather like closing the stable door after the horse has bolted. It was too late then as they were in there.

The sister told me she nearly stopped the doctor. They were very caring then but only offered me one paracetamol. They said to me don’t let the woman who is waiting outside see you or it might put her off.”

The 21-year-old sister of Michelle, from Scotland, went for a hysteroscopy after noticing some bleeding after intercourse. The gynaecologist asked a nurse to assist while he proceeded to perform a rather forceful examination, and then carried out the hysteroscopy with no warning or pain relief. Michelle received a phone call from her distraught sister, who had gone into shock in the car park, had passed out next to her car, and was bleeding.

Gillian in Leeds said:

“Before the procedure, I received a leaflet with my appointment letter—no mention of any general or local anaesthetic, but after what the doctor had told me I wasn’t expecting it to be too bad”.

She said that the nurse

“managed to get the hysteroscope through my cervical opening…when she took each sample—6 in total—my pain level shot through the roof.

“What...infuriates me most is the fact that SOME people are given pain relief as a matter of course at their hospitals…why the hell should I, and others, have to suffer just because of which hospital we went to?”

Patricia from Fife said:

“I was offered no pain relief and the Dr. who did it didn’t get enough in the end so I had to go under general anaesthetic to get it done again.”

The procedure that she experienced, while conscious,

“was very traumatic and painful…I felt them cutting away the biopsy inside…afterwards the nurse who had held me down said to me ‘I wouldn’t have let them do that to me without a general anaesthetic’ so why did she let me go through it?’”

Maureen from Norwich said:

“The letter…advised I took either ibuprofen, or paracetamol about two hours before the appointment. The scan showed something abnormal, so I waited and then saw a very nice lady doctor. I then went on to endure the procedure, it took about fifteen minutes and it was certainly a lot more than uncomfortable.”

She felt very sick, and was in pain, but

“the nurse who was there kept saying how well I was doing. I was at the limit of my endurance, only the thought of having to go back again stopped me from asking the procedure to be stopped.”

I have received so much correspondence about this issue, via my friend Debbie, that I could speak at length and give many more examples, because what I wanted to do today was give those women a voice. However, I think that the House will understand the direction in which I am going.

Some women have received no pain treatment at all—no anaesthetic to dull the pain. Some have received a local anaesthetic, but, given the severity of their conditions, a number of them have found that that is not enough. Others have received a general anaesthetic, either on request or because their doctors were aware that the procedure involved might be more extensive than had been expected. A study of a group of women conducted over five years in Melbourne established that over 10% of the group would not accept a local anaesthetic again, because of the pain and the need for the procedure to be repeated owing to a failure to secure a biopsy sample.

I have found it difficult to obtain information about this issue, but I think that certain facts are clear. Some women are being given no pain relief options at all. That aspect is not being explained to them by the doctor when they get to the hospital. Some feel that they are not being treated with compassion and respect, and that very little or no consideration is given to their dignity or their well-being. Some are experiencing a procedure that fails and needs to be repeated. One has to ask how often that happens, and what the cost is to the NHS.

Some women are clearly receiving treatment that is not in line with the guidelines issued by the Royal College of Obstetricians and Gynaecologists, which acknowledges that

“outpatient hysteroscopy can be associated with significant pain, anxiety and embarrassment”.

While the RCOG’s guidelines emphasise throughout that it is possible for women to have an acceptable out-patient experience, and some women do, there is clearly a serious problem, in that the current standard practice is failing a significant group of women very badly. It is appalling that, in some cases, no pain relief is even offered. I have read a range of the information leaflets that various hospitals offer to support their hysteroscopy out-patient clinics, and I am glad to note that local anaesthetic is mentioned in almost all of them, but they are not open enough about the pain that women may experience during and after the procedure, and there is inadequate reference to the option of undergoing the procedure with a general anaesthetic.

[Bob Stewart]

May I ask what percentage of women feel no pain whatsoever? Is there such a percentage, or does everyone experience pain—in which case, we must sort the matter out?

[Lyn Brown]

I honestly cannot answer that question, although I can say that at the different times in my life when I have had internal examinations the pain has varied, and that as I have got older, the examinations have become more painful. I have been told by some women who have had babies—which, sadly, I have failed to do—that they have found the examinations less painful after their pregnancies. However, some have told me that they become more painful with the menopause. Indeed, when my mother had a similar examination, she told me that it had been excruciating, and that was when she was quite old.

I am not sure that there are any research findings out there that would answer the hon. Gentleman’s very sympathetic question—certainly I have not found any—and I think that this is something that we need to know more about. However, a study published by the British Medical Journal in 2009 concluded that a local anaesthetic injection was the best method of pain control for women undergoing hysteroscopies as out-patients.

I have struggled to decide what I need to ask the Government to do in order to ensure that women receive the best possible care and treatment while undergoing this procedure. It is difficult for me to know that, because I am not a medic. However, I do think it is reasonable to ask the Government to use all the influence they have over policy in this area to require the National Institute for Health and Care Excellence to work with the Royal College of Obstetricians and Gynaecologists to issue authoritative guidelines. I also think the Care Quality Commission may well have a role to play in ensuring that best practice is delivered locally at each hospital.

Apprenticeships and Skills (Public Procurement Contracts) Bill

Debate between Lyn Brown and Bob Stewart

Friday 1st November 2013 Commons Chamber

[Lyn Brown]

I absolutely agree, and I am grateful to my hon. Friend.

The London Legacy Development Corporation is aware of the transient nature of the work force in sectors such as construction and has asked its contractors to monitor the length of their workers’ residency. When we were building in preparation for the Olympic games, we were keen to make sure that local people, who were being severely disadvantaged by the construction process, were able to take advantage of the opportunities that came their way.

We set up lots of monitoring schemes to find out whether the people getting the jobs and apprenticeships came from the area. Unsurprisingly, people moved into the area to take up the jobs and apprenticeships and then moved out, taking with them their skills and spending power. That, obviously, is not great; we wanted to transform the local area and make sure that local people had the advantages.

[Bob Stewart]

Has the hon. Lady any idea of how many people who were apprentices for the Olympic build successfully moved into permanent employment as a consequence of that training? Do we have that figure?

[Lyn Brown]

I am not sure whether the figure is available, but I will check that out and pass a note to the hon. Gentleman as it would interest me too. However, we did discover that apprentices based in Salford, Gateshead and Newcastle came with their firms to the Olympic park to complete their apprenticeships. Although we got additional apprenticeships, the Olympics provided opportunities for companies based elsewhere in the UK to bring their work forces down and keep them employed while we waited for the worst of the recession in building to move on or for additional work to be found.