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Can we stop female genital mutilation, even if we don’t understand it?

‘I was 6. I remember the knife. My mother pinned me down.’

My patient relayed this childhood event without emotion but as I listened, I was overcome with anger and sadness. The event, that I was finding so distressing and abhorrent to hear about had led the patient to a gynaecology consultation with me some two decades later.

She continued:

‘I don’t feel any anger towards my mother. She knew it would enable me to have a future.’

The patient explained that without genital mutilation she would have been deemed unclean and impure and would have been unable to marry anyone from the community she grew up in. She would have brought shame on her family and become an outcast.

And my patient isn’t  the only one to have experienced female genital mutilation (FGM): over 137,000 people are estimated to be living with its consequences in England and Wales.

The Government is planning to introduce mandatory reporting by 8 May. If a girl under the age of 18 discloses to a GP that she has undergone FGM, or in the course of our professional duties we find evidence of FGM, we must report it to the police. If we don’t, we will be subject to GMC disciplinary procedures.

The Government believes that mandatory reporting should lead to a greater number of victims and potential victims being identified and increase the number of perpetrators prosecuted, and that prosecutions should act as a deterrent to perpetrators and prevent FGM from occurring.

While the Government’s aims are laudable, it’s hard to see how reporting will benefit the patients being reported on It certainly won’t undo the mutilation, nor will it reduce the emotional nor physical sequelae. Indeed, there’s a big risk that subsequent police investigation will be detrimental to her health and wellbeing.

Furthermore she may not attend if she worries that she will be responsible for the prosecution of her family. Whole communities could be prevented from engaging with services.

However, reporting may protect patients’ younger sisters and cousins from the going through the same fate. It may lead her to challenge her own beliefs and protect her daughters. For those reasons I support mandatory reporting – with the strong proviso that my patient is protected from any consequent harm after I report her case.

I agree that we need to send out a strong message that FGM is a criminal offence – for those of us outside these communities, it clearly seems like a horrendous form of child abuse.

However, parents within these communities already understand the full horror of FGM. Mothers are likely to have experienced gynaecological, obstetric and psychosexual complications. Yet some of them feel that the emotional and physical suffering inflicted on their daughters is outweighed by the need to follow a cultural norm.

Unfortunately, I don’t believe that the risk of prosecution is going to alter that balance.

Personally, I believe that only the people within these communities can truly put a stop to FGM, people who courageously stand up and lead a change of cultural norm and expectation through the challenge and reform of firmly held beliefs. Maybe that’s how our profession can best contribute to the drive to condemn FGM – if GPs who belong to these communities, who fully understand the drivers, unite and lead the change.

Any volunteers?

Dr Lisa Harrod-Rothwell is a GP in Essex and former chair of a local CCG.