13 July 2015

Working with women who have experienced female circumcision, genital cutting or FGM

Guest blog by Karen Walkden.

On Thursday 9th July the British Psychological Society’s Division of Clinical Psychology’s Faculty for Sexual Health and HIV held an event for clinicians and others working with women impacted by FGM.  

In spite of a one day tube strike the event was really well attended by clinicians and professionals working across a range of service provision including voluntary sector, primary care, gynaecology, midwifery, GUM and HIV services and psychological and mental health services.

I went along to represent 28 Too Many.

There was so much to take away from the event that it is difficult to know where to start.

The event marked the launch of an NHS Choices video for health professionals commissioned by the Department of Health to increase understanding of the psychological aspects of working with women who have experienced FGM.  This follows from the very helpful and well-received NHS Choices video by Dr Sarah Creighton on understanding the medical needs of FGM.  

We started with a review of FGM practices and exploration of the ways clinicians can best work with clients who have undergone FGM as well as clients from high prevalence countries.  Staff from the Paediatric FGM service at UCLH talked through their work with children referred there – particularly to determine whether they had in fact had FGM.  A significant number of children are referred and do not appear to have had FGM in any visible way.  This suggests that there are more children experiencing it in a symbolic way eg as a pin prick.  The clinic has been going since September 2014 and is still in early days.

Case studies from a “reversal” clinic were explored.  This opened up a discussion around concepts of recording and reporting.  What is in the best interests of a women survivor?  What are the legal obligations?

The new Royal College of Obstetrics and Gynaecology will launch their guidelines tomorrow (!0th July 2015) and some features of these guidelines were explored.

The psychological impact of FGM was the focus of a further session, with an emphasis on understanding the beliefs that perpetuate the practice.  Women should be treated as a whole, and though there are trends and belief systems that typify communities, each individual will have their own story.  

As clinicians, there was agreement that the question “have you been cut?” should be asked routinely, and not by exception just for women from countries where the practice is prevalent.  Language is important and it would help if clinicians used the terms that the women they work with use to describe the vagina.

Research with women from FGM prevalent communities, and undertaken by researchers from within the cultural group, revealed some interesting insights into the perception of FGM.  Quotes from real women with personal stories showed that for some FGM was not the over riding concern in their lives.   There was a surprising level of acceptance of the practice, especially where it was accompanied by celebrations and rewards.  Whilst for others it dominated their entire being.   FGM did not always lead to Post Traumatic Stress Disorder – and some further work is needed to understand the circumstances when it does.

At one point there was a discussion about participants experiences of FGM overseas, and Sierra Leone was specifically mentioned.  At this point I was able to signpost 28 Too Many’s latest report, and to talk about our approach.  Shortly afterwards I ran out of business cards.

There is clearly an appetite to learn more about FGM.  More areas have individuals in post co-ordinating actions and improving understanding.  Equipping clinicians in a variety of roles to Recognise, Acknowledge, Educate, Support and Signpost re FGM is going to be key to eradicating the practice.

Karen Walkden AFBPsS, Vice Chair of the Board of Trustees 28 Too Many


You can learn more about 28 Too Many's work to end FGM and how you can help at www.28toomany.org. You can donate to support our research and campaigns and follow us on Facebook for updates on the global movement to end FGM.