Professor Andrew Roiwland

Action against female genital mutilation hampered by lack of information

The true scale of female genital mutilation (FGM) in England and Wales is not being properly investigated because of a lack of consistent, high-quality data, new research suggests.

The researchers are now calling for national data to be collected by a central authority, led by an FGM Commissioner.

While FGM has been illegal in the UK since 1985, it’s estimated that in 2015 there were more than 100,000 women and girls living in the UK who had been subjected to ‘cutting’, which is associated with serious long-term complications.

Immediate health consequences include severe pain, significant risk of damage to the urinary tract, bleeding, infection and possible death. Long-term effects include chronic pain, painful intercourse, urinary incontinence, recurrent urinary tract infections and complications of childbirth such as obstructed labour, still birth, severe tears, infection and haemorrhage.

But although health, social care and education professionals have had a mandatory duty since October 2015 to report any verified or suspected cases of FGM to police, a recent study by experts from The Pennine Acute Hospitals NHS Trust (part of the Northern Care Alliance NHS Group with Salford Royal), the University of Salford and a leading barrister found a huge mismatch between FGM data obtained from the Health and Social Care Information Centre (HSCIC) and data obtained from police authorities.

The study aimed to look at the number of FGM cases that were reported to the police before and after the introduction of mandatory reporting of FGM to try to ascertain what impact that legislation has had on the reporting of FGM.

Freedom of Information

Of 45 police authorities in the UK, just six responded initially to a Freedom of Information Act 2000 (FOIA) request, with three stating that no cases of FGM had been reported between October 2014 and October 2015 and also between October 2015 and February 2016.

Police Scotland and Greater Manchester Police provided a detailed response while the Metropolitan Police Service confirmed the number of cases of FGM reported to them. A further nine police authorities provided some data, either in an initial response or on appeal after initially rejecting the request.

Professor Andrew Rowland, Consultant in Paediatric Emergency Medicine at North Manchester General Hospital and Honorary Professor (Paediatrics) at the University of Salford, carried out the research with Dr Yusuf Malik, also from North Manchester General, Professor Felicity Gerry QC, a leading barrister who is also Professor of Legal Practice at Deakin University in Australia, and Senior Research Fellow Dr Fiona MacVane Phipps from the University of Salford.

Professor Rowland said: “At the present time our study has identified that the mandatory reporting and recording of FGM is more symbolic than effective. The law underpinning mandatory reporting of FGM requires full scientific evaluation so that improvements to processes can be made to guide implementation of meaningful evidence-based strategies to more effectively combat this terrible crime in the future.”

The Health and Social Care Information Centre has reported that there were on average 481 new reports of FGM each month across England between October 2014 and October 2015. By comparison, there were only 145 cases of FGM reported by Police Scotland, Greater Manchester Police and the Metropolitan Police Service combined for the entire period.

Huge mismatch

Professor Rowland added: “This huge mismatch between HSCIC and police data suggests that the medical reports are not being followed up and the true scale of FGM is not being properly investigated.

“The HSCIC records the diagnosis of FGM in girls and women of any age but this only has to be reported to police if a girl is under the age of 18 at the time the concern is raised.

“Reporting would be much more effective if there was a joint approach to data collection. Some of the police forces we contacted had concerns about sharing data in case it led to the impression that confidentiality had been broken, while others such as Greater Manchester Police quite properly gave us detailed and transparent data.

“We really need an effective system for linking recording and reporting with anonymised data available so that frontline professionals and policymakers can respond to the needs of affected women and children.

“This is a major issue of concern to all health professionals as the health consequences of FGM are potentially catastrophic.”

Dr MacVane Phipps said: “In recent years, members of the midwifery and obstetric professions have become increasingly aware of the serious health risks FGM poses for a significant minority population. Health professionals cannot tackle the deleterious effects of this practice alone but they can help to inform other professional groups such as teachers, social workers and the legal services about the urgency of addressing this issue. Further interdisciplinary research and collaborative working practices would seem to be the way forward to ensure that no girl or woman resident in the UK will have to suffer this assault on her urogenital integrity and reproductive health.”

The study found that the FGM data that does exist is not in a format that helps policymakers and professionals to target preventative strategies towards particular age groups and their communities. Police Forces in the UK are not collecting data or responding to requests for information about FGM in a consistent fashion. Up until April 2018 the Home Office and Office for National Statistics were aggregating FGM data with other assaults and the value of recording the data was lost entirely.

Professor Felicity Gerry QC said: “FGM is a continuing violation of the rights of women and girls. Our research shows that the improvements made in law and practice in 2013 have not been subject to meaningful evaluation which puts any progress towards the eradication of FGM at risk.”

Proposals for improvement

The study’s authors believe that there ought to be a cross-party approach to solving the issues that have been clearly identified in their scientific paper and that there should be an effective system for linking recording and reporting of FGM data to allow for meaningful follow-up, and for de-identifying data for both public consumption and legal-medical research.

Three firm proposals have been made in the paper:

  • Aggregate FGM national data should be collected by a central authority, led by an FGM Commissioner.
  • A joint-approach to the collection of FGM data between the NHS and the police should be adopted whereby NHS data is collected against the same criteria as police data and that clinicians’ recordings are similarly subject to aggregate analysis.
  • New guidance should be issued to police forces indicating how they should respond to requests for information regarding FGM, where that information being sought is anonymised data for the purposes of research into the effectiveness of the legislation requiring the reporting of FGM.