The London clinic fighting back against female genital mutilation

Natasha Tsangarides visits the West London African Women's Community Centre, which carries out "reversal" surgery for FGM survivors and campaigns for stronger protection for women.

Maryam* has just come out of surgery at the West London African Women’s Community Clinic. The 24-year-old Londoner was a victim of female genital mutilation (FGM) in her home country, Somalia.

The West London clinic offers a vital service for FGM survivors. Maryam has just had “reversal” surgery, a procedure to open up the vagina, which had been sewn up during FGM. “It’s amazing, I didn’t realize I wouldn’t feel pain,” she said. “My legs were shaking from fear but I didn’t feel a thing.”

Maryam was 10-years-old when she was “cut” in Somalia. “I remember the day,” she recalled. “My mum sent me to the shop to get a needle and thread. I knew what was going on. The old lady had already done it to girls on my street that day. I felt ashamed if I didn’t do it.

“Recently I got married. I suffered with sex. There’s no reason for my vagina to be closed. My husband is Somali so he expected I would be cut. When my husband realised I was closed though, he was disappointed. He said, ‘You’d better open this up’. He’s going to be happy now.”

The West London African Women’s Community Clinic, based at Charing Cross hospital, runs an FGM service every Wednesday afternoon. The clinic is a pioneering centre set up in 2010 to deliver services for women suffering the consequences of FGM. Treating women mostly from the Somali community, the clinic is breaking the taboo surrounding the procedure.

This November, several campaigns have been launched nationally in order to raise awareness and eliminate the practice of FGM in the UK. What is the scale of the problem and who is affected by it? What are the health consequences for victims of FGM? With the practice happening behind closed doors, can it really be eliminated in the UK?

FGM involves cutting female genital organs for non-medical reasons. In the UK, over 20,000 girls are at risk and 66,000 women are living with the consequences of FGM, according to a  study carried out by the anti-FGM charity, Forward.

A cultural practice, FGM developed to preserve women’s virginity and control sexuality. It is prevalent in 28 countries in Africa and in parts of Asia and the Middle East. 

97% of women in Somalia undergo the horrific procedure, typically between the ages of 5 and 9 years old, according to a 2007 study by the London School of Hygiene and Tropical Medicine. The study estimated that 15,272 Somali women aged between 15 and 49 are living with FGM in England and Wales.

Somalis comprise one of the largest ethnic groups in Hammersmith and Fulham. The 2011 census shows that 45% of the population in White City is foreign-born. The majority (636 people) come from Somalia, of which just over half are women.

With the practice so ingrained in Somali culture, migration to the UK has not stamped it out. Some second-generation girls born in the UK are being sent back to their parent’s countries of origin or, probably less commonly, having the procedure done here.

Freedom of Information requests submitted by the Evening Standard show that 2,115 FGM patients were seen at London hospitals between 2010 and summer this year.

The West London African Women’s Service provides gynaecology, maternity and sexual health care for women who have undergone FGM. It is delivered at two sites: at Chelsea and Westminster Hospital as well as the community clinic at the West London Centre for Sexual Health, Charing Cross Hospital. Between June 2011 and August 2013, 662 women with FGM have accessed the service, of whom 432 attended the community clinic.

The impact of the service has not gone unnoticed. In 2012, it won two all-party parliamentary maternity awards for most marked improvement in a service to address health inequalities and the best example of a service to address complex needs, and this year it also won the accolade of ‘Adult Sexual Health Service of the Year’ by the UK Sexual Health Awards.

Sagal Osman, an anti-FGM campaigner from White City, helps local West London women access the clinic. Originally from Somalia and a survivor of FGM, Sagal developed relationships with practitioners at Charing Cross hospital and secured regular clinics for FGM patients at the West London African Women’s Community Clinic. 

Sagal said: “At the moment I have five new patients every week and I have a waiting list of about 50 people. Most patients are Somalis. It’s probably the hardest community to reach. But over the years trust has been built.”

Women come to the clinic for a variety of reasons, typically stemming from the long-term consequences associated with FGM. These include recurrent urinary infections, painful scarring, severe menstrual cramps, wound infections, fertility problems, complications in pregnancy and even renal impairment or failure.

Dr Naomi Low-Beer, Consultant Gynaecologist at Chelsea and Westminster Hospital, and lead doctor for the FGM service at the West London clinic, performs the invaluable reversal surgery. She explained: “With the most severe type of FGM, the clitoris and labia have been totally removed, the vaginal opening closed, with a tiny passage left for urine and menstrual blood. This makes sex painful or impossible.

“Women with this type of FGM do benefit from surgery. It is often referred to as ‘reversal’, but rather than reversing the FGM the surgery opens the vagina so that women can have sex without pain. Otherwise, it can take months and months of painful attempts at penetration.  A number of women come in to have the surgery pre-marriage or before their first relationship, and others come because they are suffering from repeated urine and vaginal infections or very painful periods. The surgery can help women with these problems too. It can be safely performed under local anaesthetic in the outpatient clinic. In offering this service, you feel like you’re making a difference.”

Naomi works closely with an all-female team of committed specialists, including an obstetrician, FGM specialist midwife, doctors specialising in HIV and Sexual Health, and of course Sagal Osman, anti-FGM campaigner and health advocate. Between them they provide comprehensive specialist care for women with FGM. Between June 2011 and August 2013, of the 662 women attending the West London African Women’s Service 69 women had de-infibulations, otherwise known as reversal surgery, of whom 37 had this performed at the West London clinic.

Alia*, draped head-to-foot in black, sits nervously in the clinic’s waiting room. Having had reversal surgery four weeks ago, she is at the clinic to treat syphilis and Hepatitis B, infections commonly attributed to dirty tools used during FGM. Despite having the infections, Alia is optimistic following the successful surgery. She says, “I feel better and I feel like my life has changed.”

Tending to the needs of women suffering the after-effects of FGM is only one part of the problem. Preventing it from happening is something campaigners, frontline workers and the government have been battling with for almost thirty years. 

In July this year, Hammersmith and Fulham Council passed a special motion that proposes to raise awareness and end all forms of FGM in the borough. Councillor Helen Binmore said: “We have just set up a strategic board and hope that our coordinated multi-agency approach will help improve how agencies, services and professionals respond to this issue and offer protection to women and girls from FGM.”

Efua Dorkenoo OBE is Advocacy Director at Equality Now, an international human rights organisation.  She said: “Parents know about the health consequences but it still goes on. Parents need to know that professionals are keeping an eye on their children and that they will report FGM happening and that there can be prosecutions.”

FGM has been a criminal offence since 1985 and the 2003 Female Genital Mutilation Act made it illegal for British citizens and permanent residents to practice FGM within and outside the UK. To date, there have been no prosecutions. By comparison, France has convicted around 100 parents and practitioners.

Misplaced cultural sensitivities, a failure to see FGM as a child protection issue and a lack of accountability have so far impeded successful prosecutions taking place, Mrs Dorkenoo said. “The issue needs to be brought into the mainstream as a child abuse issue through a combination of education, protection and prosecutions.” 

Momentum is growing in the campaign to raise awareness and eliminate FGM with the government making it a national priority.  Last month, the London Metropolitan Police have, for the first time, arrested two people suspected of performing FGM on a five-week old girl. The case is under investigation and a  successful prosecution would be a landmark victory and an important step to achieving the goal of eliminating FGM.

On a local level, change is happening. Sagal Osman is optimistic. “Women suffer pain and now have a place to go. People have more trust in sexual health. Women are opening their eyes and their lives are changing.”

*Some names have been changed 

A woman walks past an anti-FGM campaign banner in Nairobi, Kenya. Photo: Getty.
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Why the world depends on our attitude towards ten-year-old girls

A new report by the United Nation Population Fund finds that our collective future rests on how we support the world’s 60 million ten-year-old girls as they start their journey from adolescence to adulthood.

Take a moment to imagine a ten-year-old girl right now. What do you see? Is she in school? Is she laughing with friends? Do you imagine her riding a bike or playing ball? On roller skates or en pointe in ballet class?  With her nose in a book or her eyes on a chess board?

Or perhaps you imagined a different scene, one that still plays out daily in many parts of the world: a girl who wakes up in the morning and finds out that she’ll be married that afternoon and taken out of school forever, a girl who will be forced to start bearing children as soon as her body allows it, and will stop being a child and start being a labourer in the home.

This is the tragic reality for millions of ten-year-old girls as they approach puberty.

While in some places, age ten can be a time of exploration, expanding horizons and new possibilities, in others it can be a time where barriers emerge, limiting options, choices and opportunities.

Many girls are transformed from children with rights and aspirations, into brides, free labour or objects of exploitation – forever excluded from decisions about their lives and blocked from realising their full potential.

This is a grave and unforgivable injustice and a violation of girls’ fundamental rights. And whenever a girl’s future is derailed in this way, her household, community and nation also suffer.

With no freedom to make choices, get an education and find a good job, she will never have the power to participate in the affairs of her community and contribute to her country’s development.

But when a girl is protected from child marriage, is able to stay in school and make her own decisions about whether or when to become pregnant, the potential gains to her – and her society – are huge.

Each extra year a girl stays in high school, for example, delivers an 11.6 per cent increase in her average annual wage for the rest of her life. In India alone, there are over 12 million ten-year-old girls of whom nearly 900,000 will not move from primary to secondary school this year. If half of those 900,000 girls finished secondary school and later got a job, they could together earn almost $2m over the next 15 years.

In fact, if all the ten-year-old girls living in developing countries today were able to finish high school and make their own decisions about marriage and parenthood, they would together earn an estimated $21bn by the time they reach 25.

In most developing and middle-income countries, a girl who stays in school, gets a job and delays pregnancy will earn up to three times as much in her lifetime as her counterpart who does not finish high school and becomes pregnant as an adolescent.

And research has shown that a girl who makes a safe and healthy transition through adolescence to adulthood has higher status in her household and community and invests earnings back into her household, setting in motion a virtuous cycle of social and economic empowerment that can last for generations.

The benefits of keeping a ten-year-old girl’s life on track are indisputably large.

According to The State of World Population 2016, published today by UNFPA, the United Nations Population Fund, keeping every ten-year-old girl’s life on track is possible, but it requires support from, and investments by, everyone around her – her family, community and government. Men and boys also have a critical role in tearing down the barriers that prevent girls from realising their full potential.

So what can be done?

First, end all practices that harm girls. This means, for example, enacting and enforcing laws that prohibit child marriage.

Second, enable girls to stay in school, at least through high school. Study after study has shown the longer a girl stays in school, the less likely she is to become pregnant as an adolescent and the more likely to grow up healthy and join the paid labour force.

Third, provide extra support to marginalised and impoverished girls who have traditionally been left behind.

Make sure girls, before they reach puberty, have access to information about their bodies. Later in adolescence, they need information and services to protect themselves from unintended pregnancy and sexually transmitted infections, including HIV.

And above all, take steps to protect girls’ – and everyone’s – rights.

We have every reason to prioritise the development of every girl’s capabilities. Our collective future depends on it.

Today’s 60 million ten-year-old girls will be 24 when progress towards the United Nations’ new development agenda is tallied in 2030.

That agenda aims for inclusive, equitable and sustainable development that leaves no one behind. The real test of its success will be whether every ten-year-old girl today will be healthy, educated and productive in 2030.

The world cannot afford to squander the potential of even one more girl. Instead, we must do everything in our power to ignite that potential – for her sake and for the sake of us all.

Dr Babatunde Osotimehin is the United Nation Population Fund’s (UNFPA) Executive Director.