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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Putin's vote-winning trick? He makes power personal

Representatives in the Russian parliament, the Duma, have long been unpopular. Yet President Putin is immune to voter's discontent.

A week before Russia’s parliamentary elections, the central square in Ekaterinburg – the fourth-largest city in Russia, a thousand miles east of Moscow – was packed with people, huddling close on a wet September night. They faced a stage decorated with a poster imploring the crowd to vote for “ours”, meaning United Russia, Vladimir Putin’s political party.

Yet it wasn’t politics for which thousands of people had braved the rain – it was music. During the perestroika and glasnost years of post-Soviet openness, Ekaterinburg was the cradle of the Russian rock scene. The home-grown bands Nautilus Pompilius, Chaif and Agata Kristi sang about freedom and change. Thus, this free concert to celebrate the 30th anniversary of the legendary Sverdlovsk Rock Club was bound to draw a crowd, and United Russia latched on to that.

A message from Dmitry Medvedev, the United Russia leader, praising local rock bands for their bravery “in those days when freedom was in deficit”, was read to the assembled fans. If freedom was a powerful word thirty years ago it has little impact on Russians today. Turnout in the election on 18 September was less than 50 per cent (and only 41.5 per cent in the Ekaterinburg region), a sign of the general political apathy. Before they went to the polls, it was hard to find anyone who was enthusiastic about voting.

“Why should I bother with voting? The result is clear: United Russia will, as always, win,” says Vyacheslav Bakhtin, who owns a small construction company in Ekaterinburg. He added: “Elections are the last thing on my mind. My business has been suffering for the last two years. We couldn’t even afford to go on a family vacation this summer.”

The Russian economy is struggling because of low oil prices, trade embargoes and geopolitical concerns. There have been public spending cuts, and the free float of the rouble led to currency devaluation and high inflation (7 per cent in August). Unemployment is rising and the base interest rate is 10.5 per cent.

There are many reasons for Russians to want a change in government, yet it appears that people do not see the link between their daily struggles and Putin’s policies.

Anna Mikhailova has recently returned from a tour of the Golden Ring of Russia (a circuit of medieval cities to the north-east of Moscow), where there is a stark contrast between the restored onion-domed churches and the crumbling villages.

“People live in poverty in crammed kummunalki [Soviet-style communal flats with several families sharing one kitchen and bathroom],” she tells me. “But they still talk about Putin the Saviour, standing up for Mother Russia.”

Apart from United Russia, 13 parties were judged eligible to stand, but the range of choice was an illusion. Olga, who requested anonymity for her own safety, explained. “We have one party – United Russia – a few pseudo-opposition parties, the Communists, the LDPR and Fair Russia who support Putin’s cause, and a bunch of nobodies that people don’t care about.”

Indeed, Gennady Zyuganov, who has led the Communist Party since 1993, campaigned under the slogan “Ten Stalinist punches against capitalism”. But although he criticised Medvedev, he didn’t touch Putin. The populist leader of the Liberal Democratic Party of Russia (LDPR), Vladimir Zhirinovsky, another political dinosaur, actively endorses Putin’s foreign policy.

If there is discontent among voters, Putin is immune to it. On the eve of the elections, United Russia’s popularity slid to just 30 per cent of total respondents in one poll, though it scored 50 per cent among those who said they were definitely going to vote. Medvedev’s own approval rating fell to 48 per cent. His message to the elderly that state pensions wouldn’t increase, and his advice to teachers to get jobs in the private sector if they weren’t happy with their state salaries, might have had something to do with it. Yet Putin’s popularity remained consistently high, at 82 per cent, according to independent pollsters the Levada Centre.

Alexey Volkov, a 40-year-old business manager, says he voted for the Communists. “I voted against United Russia, the apparatchiks stifling the president,” he explains. “Putin, on the other hand, is the best ruler since Alexander III [Russia’s emperor at the end of the 19th century].”

Representatives in the Russian parliament, the Duma, have long been unpopular and considered ineffective by the Russian people. Over the past 16 years, presidential power has expanded hugely. Since Russia adopted its new constitution in 1993, successive presidents have introduced legislation to stretch the office’s authority. In his first term as president, Putin acquired 219 new rights and duties, and as his successor Medvedev enjoyed an additional 114 responsibilities. These range from educational appointments to federal government decisions.

As predicted, United Russia topped the ballot with 54 per cent of the vote. Putin’s party claimed 343 of the 450 seats (up from 238 in 2011). The same four parties will form the Duma. The Yabloko and PARNAS parties, seen by voters as a token gesture of protest against the Kremlin, gained negligible support, with 2 per cent and 0.7 per cent, respectively.

It is ultimately Putin’s victory. In the eyes of the majority, he has restored Russia’s strength abroad, revived the defence industry and army, and reinvigorated the country with patriotism. The latter was accomplished via manipulation of the media, which has reinstated the West as the enemy and focused attention on foreign affairs at the expense of the social and economic agenda at home.

Still, with the low turnout, only 26 per cent of eligible Russians voted for Putin’s party. Though that was enough to tighten the president’s grip on the Duma, nationwide the elections paint a picture of a dejected Russia just beginning to feel discontent with the status quo. It is not yet enough to unseat Putin, but as the old Russian saying goes: a drop of water can cut through stone.

This article first appeared in the 22 September 2016 issue of the New Statesman, The New Times