24 PROFESSIONAL
Painful intercourse , lack of pleasurable sensations . Infertility . Prolonged / obstructed labour and childbirth trauma . Postnatal wound infection . Many women present through maternity services , but primary care nurses are likely to come across women who have undergone FGM in their routine practice . ‘ Anyone who is conducting cervical screening , for example , will need to have a clear understanding of what normal physiology looks like , and recognise a woman may present with evidence that she has had FGM performed ,’ Ms Bagness says .
She adds that any area of practice relating to women ’ s or girls ’ health – particularly involving urology , gynaecology or mental health – could potentially include a conversation about FGM or trigger a disclosure . Nurses should also be alert when they encounter women and girls from diaspora communities who are travelling abroad to any region where FGM practices are concentrated .
Legal and professional responsibilities As mentioned above , the law requires nurses and other regulated professionals to make a report to the police if , in the course of their professional duties , they discover FGM appears to have been carried out on a girl aged under 18 years ( at the time of discovery ).
The duty applies where the professional is informed by the girl that an act of FGM has been carried out on her , or observes physical signs that appear to indicate FGM , and has no reason to believe it was necessary for reasons of physical or mental health , or connected with labour or birth .
Note that the mandatory duty to report applies if FGM is discovered and not if it ’ s merely suspected , and only in under-18s . Uncertainty may arise when caring for a pregnant woman who has had FGM , and whose child – if female – might therefore also be at risk of FGM . In this case , an individual risk assessment should be undertaken . 4
Such policies can cause immense distress , and risk alienating diaspora communities . Earlier this year , the Foundation for Women ’ s Health Research and Development , known as FORWARD , published research with the University of Huddersfield , which outlined that women can feel criminalised by ‘ heavy-handed ’ FGM safeguarding measures .
Main points
FGM is a cultural practice , not a religious one . There is no health or medical benefit from FGM . It is usually performed on girls between infancy and the age of 15 , typically before puberty .
The physical and psychological harms to girls and women who have undergone FGM are often severe and lifelong .
Girls and women are often unaware of what has happened to them .
Different cultures may use different terms to describe and talk about it , so might not understand terminology like ‘ female genital mutilation ’.
Nurses must be familiar with FGM guidelines and duties , know their safeguarding lead and understand local risk assessment and safeguarding processes .
Amy Abdelshahid , the charity ’ s head of evidence and co-author of the report , Do No Harm 5 , says it highlights that , paradoxically , safeguarding often undermines the welfare and safety of the women and girls it is designed to protect .
‘ It ’ s required to record on a girl ’ s health record that she is at risk of FGM if she is born to a mother who has had the practice . That suggests any girl born to a mother with FGM is automatically at risk ,’ Ms Abdelshahid says . ‘ A lot of women who are pregnant or recently gave birth have to endure repetitive , uncomfortable conversations about their FGM or about their intention to have FGM done on their daughters . ‘ That ’ s not necessarily done only once , but routinely , because the girl is considered at risk until she ’ s 18 . That can be very difficult , because mothers who have had FGM have gone through trauma and feel they are not necessarily treated as survivors of FGM , but as potential perpetrators .’
These experiences erode rather than build trust between healthcare professionals and diaspora communities . Women often end up avoiding medical appointments as a result , potentially putting themselves and their families at greater risk .
Difficult conversations Ms Abdelshahid highlights that meaningful progress in eliminating FGM will only happen if interventions are culturally sensitive and inclusive . ‘ We recognise that a communitycentric approach to FGM safeguarding and prevention is very important and has a significant impact on changing attitudes to FGM and protecting girls ,’ she says .
Practice nurses have a crucial role to play here , and adopting a sensitive approach begins with reflecting on how they talk about FGM with patients . Aneeta Prem , campaigner and founder of Freedom charity , says getting the language right can encourage women to open up .
‘ If you ’ ve never seen an FGM case , it ’ s difficult to know what language to use and how to speak to someone ,’ she says . ‘ When I talk to someone who has been through FGM , my first question is always : “ How do you want to talk about this ?” Depending on where they ’ re from , they ’ ll often prefer to say they ’ ve been “ cut ” and “ sewn ”, or they might use a native word . As professionals , it ’ s essential that we use the language women are happy with .’
Many patients for whom English is not their first language take a relative or friend to consultations to translate . As Ms Bagness points out , nurses should exercise caution here . ‘ That would not be agreed policy – you should have an independent interpreter – and you need to be clear about providing the woman with a safe opportunity to talk about it if she wants to ,’ she says .
Allie Anderson is a freelance journalist
References 1 NHS Digital . Female genital mutilation – Jan-March 2021 . Leeds : NHS Digital , 2021 . bit . ly / 3hXKunS 2 RCN . Female genital mutilation . London : RCN , 2021 . bit . ly / 2QZaKTW 3 RCN . Female genital mutilation . A resource for nursing and midwifery practice ( 4th edition ). London : RCN , 2019 . bit . ly / 34n2FeP 4 RCOG . Female genital mutilation and its management . London : RCOG , 2015 . bit . ly / 3fs9phM 5 Abdelshahid A et al . ‘ Do no harm ’. FORWARD , February , 2021 . bit . ly / 3vvTlRJ 6 Orchid Project . Impacts of Covid-19 on female genital cutting . September , 2020 . bit . ly / 3fSV1y0 7 Merrick R . Funding to stop female genital mutilation reduced by 76 per cent despite hundreds of new cases each month . Independent , 20 July 2020 . bit . ly / 3hXGfs 8 UNFPA . Millions more cases of violence , child marriage , female genital mutilation , unintended pregnancy expected due to the Covid-19 pandemic . 28 April 2020 . bit . ly / 3ySN3Oi
Resources
RCN . FGM : Guidance and resources to support nurses , midwives , nursing associates and related health care professionals . bit . ly / 2ThI5tT
FORWARD forwarduk . org . uk Freedom freedomcharity . org . uk nursinginpractice . com Summer 2021