When Leyla Hussein began campaigning against female genital mutilation (FGM) a decade ago, it provoked a violent reaction from some of her fellow British Somalis. The threats against her grew so severe that she was forced to move home several times, and was issued with a panic alarm.
"I was one of the first people who started saying, 'stop painting FGM as a cultural practice, call it what it is: it's child abuse,' and that really painted me as a girl who'd betrayed her people," she says.
Today she works for Daughters of Eve, a charity she co-founded in 2010 to protect and support girls at risk of FGM, and says she has few regrets. "I know the horrors of FGM, and they are far worse than what I was experiencing."
Hussein's experience is an extreme example, but a fear of speaking out is one reason there's so much ignorance surrounding FGM. 6 February is the International Day of Zero Tolerance to FGM, and although genital cutting is commonly understood to take place abroad — across Africa, the Middle East, and Asia — few know it's a UK issue too.
An estimated 66,000 British women have undergone FGM, and 24,000 British girls under the age of 15 are deemed by the Home Office to be “at risk” from genital cutting.
There are four main types of FGM, ranging from the removal of all or part of the clitoris, to infibulation, or “type 3”, where the vaginal opening is narrowed by cutting and sewing together the outer labia, sometimes first removing the inner labia and clitoris.
FGM is rarely carried out by a medical professional, and as well as causing pain and psychological trauma, women face a permanent risk of infection, difficulties urinating and menstruating, and complications during child birth.
Alia was seven when she was sent from the UK to Djibouti to undergo type 3 FGM. The procedure was carried out by a traditional cutter and without anaesthetic.
From her mother — who today maintains she did Alia a "favour" and made her look "prettier" — to her teacher who dismissed her experience as a "cultural practice" similar to a Bar Mitzvah, to the doctor who reversed her infibulation five years later after Alia suffered repeated urinary infections, "nobody ever asked me if I was OK," she tells me.
Nor did the doctor report Alia's case to social services, although he operated on her in the mid-nineties and FGM has been illegal in the UK since 1985. In fact, no one has ever been convicted in the UK for carrying out FGM.
"People know the UK's a soft touch," says Alia. "There are a large number of Swedish, Dutch and other European girls who have moved to the UK, just so they can undergo FGM."
Hussein confirms that she too has spoken to families who say they moved to the UK for this reason. "Britain is one of the richest, safest countries in the world, but now it's becoming a place where girls' genitals are being removed," she says.
She's keen for FGM to be included in mandatory child protection training for medical professionals, social workers and teachers: the lack of awareness of FGM among these groups was raised by everyone I spoke to.
In November 2012 there were signs of increased government resolve to clamp down on FGM. Keir Starmer, director for public prosecutions, launched a plans he hopes will increase referrals and prosecutions for FGM, and the Home Office issued a health passport, a booklet relatives can take abroad, explaining that FGM (even when carried out abroad) carries a maximum 14-year prison sentence.
Sara, a Somali anti-FGM advocate, believes the health passport could prove a useful resource for her community (provided they can read English). "Often women coming home with their daughters are hearing from their grandmothers, 'you're becoming so Western, why are you not carrying on our traditions?' So this is a reminder to them to resist," she tells me.
Nevertheless Sara is concerned that in trying to clamp down on FGM, professionals overlook the need to care for victims. Having undergone FGM herself, it took three months for a doctor to convince her to have a smear test, because she feared his reaction. Some "women prefer to have a baby in Somalia, because they are so scared of the midwife ringing social services," she says.
"It's not seen as a priority, how to care for these women" says Kekeli Kpognon, head of UK programmes at anti-FGM charity Forward, "You talk about prosecution, punishment and prevention, fine, but you don't talk about everyday care and support."
Kpognon also believes the government hasn't thought through the implications of increasing prosecutions for FGM: "It's not clear what kind of support or legal aid is being offered. People also need to realise it will mean the end of family life as it was, and what will that mean for a young girl: will her parents end up in jail? Will she go into care?"
Forward fears that a renewed focus on prosecution could divert resources away from community outreach work. It says that following its training sessions with affected women, which cover the health risks of FGM and tackle common misconceptions, such as that the practice is religiously proscribed, most women change their views, and want to convince their peers to abandon the practice too.
The lack of resources being diverted to the issue is also Hussein’s biggest worry. "I'm so scared that with all of the cuts happening at the moment, that organisations working with women and children on this will close down. I feel so worried that in the next 5-10 years, FGM will get lost in the air again.
Some names have been changed to protect identities.