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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After Article 50 is triggered, what happens next?

The UK must prepare for years, if not decades, of negotiating. 

Back in June, when Europe woke to the news of Brexit, the response was muted. “When I first emerged from my haze to go to the European Parliament there was a big sign saying ‘We will miss you’, which was sweet,” Labour MEP Seb Dance remembered at a European Parliament event in London. “The German car industry said we don’t want any disruption of trade.”

But according to Dance – best known for holding up a “He’s Lying” sign behind Nigel Farage’s head – the mood has hardened with the passing months.

The UK is seen as demanding. The Prime Minister’s repeated refusal to guarantee EU citizens’ rights is viewed as toxic. The German car manufacturers now say the EU is more important than British trade. “I am afraid that bonhomie has evaporated,” Dance said. 

On 31 March the UK will trigger Article 50. Doing so will end our period of national soul-searching and begin the formal process of divorce. So what next?

The European Parliament will have its say

In the EU, just as in the UK, the European Parliament will not be the lead negotiator. But it is nevertheless very powerful, because MEPs can vote on the final Brexit deal, and wield, in effect, a veto.

The Parliament’s chief negotiator is Guy Verhofstadt, a committed European who has previously given Remoaners hope with a plan to offer them EU passports. Expect them to tune in en masse to watch when this idea is revived in April (it’s unlikely to succeed, but MEPs want to discuss the principle). 

After Article 50 is triggered, Dance expects MEPs to draw up a resolution setting out its red lines in the Brexit negotiations, and present this to the European Commission.

The European Commission will spearhead negotiations

Although the Parliament may provide the most drama, it is the European Commission, which manages the day-to-day business of the EU, which will lead negotiations. The EU’s chief negotiator is Michel Barnier. 

Barnier is a member of the pan-EU European People’s Party, like Jean-Claude Juncker and German Chancellor Angela Merkel. He has said of the negotiations: “We are ready. Keep calm and negotiate.”

This will be a “deal” of two halves

The Brexit divorce is expected to take 16 to 18 months from March (although this is simply guesswork), which could mean Britain officially Brexits at the start of 2019.

But here’s the thing. The divorce is likely to focus on settling up bills and – hopefully – agreeing a transitional arrangement. This is because the real deal that will shape Britain’s future outside the EU is the trade deal. And there’s no deadline on that. 

As Dance put it: “The duration of that trade agreement will exceed the life of the current Parliament, and might exceed the life of the next as well.”

The trade agreement may look a bit like Ceta

The European Parliament has just approved the Comprehensive Economic and Trade Agreement (Ceta) with Canada, a mammoth trade deal which has taken eight years to negotiate. 

One of the main stumbling points in trade deals is agreeing on similar regulatory standards. The UK currently shares regulations with the rest of the UK, so this should speed up the process.

But another obstacle is that national or regional parliaments can vote against a trade deal. In October, the rebellious Belgian region of Wallonia nearly destroyed Ceta. An EU-UK deal would be far more politically sensitive. 

The only way is forward

Lawyers working for the campaign group The People’s Challenge have argued that it will legally be possible for the UK Parliament to revoke Article 50 if the choice is between a terrible deal and no deal at all. 

But other constitutional experts think this is highly unlikely to work – unless a penitent Britain can persuade the rest of the EU to agree to turn back the clock. 

Davor Jancic, who lectures on EU law at Queen Mary University of London, believes Article 50 is irrevocable. 

Jeff King, a professor of law at University College London, is also doubtful, but has this kernel of hope for all the Remainers out there:

“No EU law scholar has suggested that with the agreement of the other 27 member states you cannot allow a member state to withdraw its notice.”

Good luck chanting that at a march. 

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.