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Has the pandemic allowed FGM rates to rise ?
One possible reason for the drop in recorded FGM cases is the Covid-19 pandemic . Evidence suggests that , worldwide , Covid has enabled genderbased violence and abuse , including FGM , to be perpetrated behind closed doors while victims and those at risk have reduced access to medical and support services .
According to Orchid Project , a UK-based non-governmental organisation whose aim is to end FGM globally , rates in parts of the world are in fact on the rise because ‘ lockdowns are being seen as an opportunity to carry out [ FGM ] undetected ’. 6 The UN Population Fund ( UNFPA ) estimates that ‘ due to pandemic-related disruptions in prevention programmes , two million FGM cases could occur over the next decade that would otherwise have been averted ’. 7
Freedom charity founder Aneeta Prem believes this is being borne out in the UK . ‘ We ’ ve had a 45 % increase in calls to our helpline ,’ she says . ‘ Previously , those people might have spoken to a nurse or someone else .’
Those missed encounters may have given rise to concerns that would be covered by the mandatory reporting duty , which falls on all regulated health , social care and teaching professionals . With schools closed for a significant part of 2020 and face-to-face visits with frontline health and social care workers limited , at-risk girls could certainly have fallen through the gaps .
Declining official numbers of cases also threaten specialist FGM services , Carmel Bagness warns . ‘ Healthcare across the NHS is provided and commissioned on the basis of identified need ,’ she says . ‘ If there isn ’ t hard evidence to show there is a need , then there is a real risk that it will have a negative impact on services that are commissioned , set up or maintained .’ As Ms Bagness suggests , the absence of data to demonstrate a service need puts funding in jeopardy . Notwithstanding the impact of Covid-19 , official NHS figures have shown a steady , year-on-year reduction in recorded cases of FGM since the first published data in 2016 . Government money to eradicate the practice has plummeted in parallel – from £ 2.7m in the year to April 2016 , to just £ 432,000 four years later . 8
As a result , frontline healthcare workers face an even greater responsibility to be on guard and fully understand their obligations when it comes protecting their patients who have undergone or are at risk of FGM .
Ms Bagness concludes : ‘ There ’ s an ongoing need to ensure that all nurses , midwives and healthcare professionals right across health and social care understand that FGM is everybody ’ s business . It is incumbent on them to be aware , and to try to raise awareness within their communities about FGM and not shy away from talking about it .’
Carmel Bagness , the RCN ’ s professional lead for midwifery and women ’ s health , points out that this responsibility falls particularly on practice and community nurses , who are at the coalface of the affected populations . ‘ Nurses in primary care are more likely to be in contact with whole families and therefore have a better understanding of the communities they ’ re working in ,’ she says .
What is FGM ? Female genital mutilation , also known as female cutting or female circumcision , is a catch-all term that describes partial or total removal of the external female genitalia , or other injury to the female genital organs for non-medical reasons .
The World Health Organization classifies FGM into four main types :
Clitoridectomy the partial or total removal of the clitoris , or the removal of the prepuce ( clitoral hood ). This is rarely , if ever , performed without one of the other types .
Excision the partial or total removal of the clitoris and the labia minora , with or without excision of the labia majora .
Infibulation the narrowing of the vaginal opening through the creation of a covering seal . The seal is formed by cutting and repositioning the labia , with or without clitoridectomy .
Other all other harmful procedures to the female genitalia for non-medical purposes , such as pricking , piercing , incising , scraping and cauterising .
Mothers who have had FGM have gone through trauma and feel they ’ re not necessarily treated as a survivor of FGM , but as a potential perpetrator
Complications and presentations to services FGM affects the physical and mental health of women and girls in manifold ways , in the short term and throughout their lives . 3
Immediate complications Haemorrhage , pain , shock . Wound infection , septicaemia , tetanus . Urine retention . Tissue damage , ulceration . Infection .
Intermediate complications Delayed healing . Abscesses . Scarring / keloid formation . Dysmenorrhoea / obstruction to menstrual flow . Pelvic infections . Obstruction to urinary flow . UTIs .
Long-term complications Psychosocial trauma / PTSD . Vaginal closure . Epidermal cyst / neuromata . Pain and chronic infection . Recurrent UTIs / renal damage .
Summer 2021 nursinginpractice . com