The Royal College of Obstetricians and Gynaecologists (RCOG) welcomes the report of the Home Affairs Committee Female genital mutilation: the case for a national action plan.
The RCOG agrees with the report’s strong position on FGM; that the practice is:
“…a severe form of gender-based violence, and where it is carried out on a girl, it is an extreme form of child abuse. Everyone who has a responsibility for safeguarding children must view FGM in this way.”
This ensures that early intervention systems can be put in place by health and social services to protect and care for at-risk girls and their families. It also reminds health and social care professionals of their duty of care towards girls and women regarding FGM.
Many of the recommendations of the Committee report echo the recommendations of the Intercollegiate Group report on FGM published in November 2013. The role of data collection and the sharing of information between agencies, along with the development of care pathways and training materials for healthcare professionals are acknowledged by the Committee.
The RCOG agrees that clinicians sometimes have difficulty discussing the issues when dealing with children and / or women from ethnic backgrounds. This may become a barrier in the surveillance of at-risk girls and women. Better tools and training to improve the confidence of healthcare professionals so that they can address FGM issues with those in their care in a non-judgemental but direct way would be helpful.
The life-course approach should be adopted to help tackle FGM and the proposal by the Committee to question the FGM status of the mother and her intentions for her unborn child at the antenatal booking interview has the support of the RCOG. The RCOG suggests that such information is recorded and shared between the GP, obstetrician, gynaecologist, midwife and health visitor so that better postnatal care can take place. This should also include a reminder to the mother of the long-term harm of FGM during a follow-up visit or after discharge. Similarly, healthcare professionals should be alert to any signs of physical or psychological trauma in the mother that could affect post-birth recovery and the care of the newborn.
The proposal by the Committee to include FGM risk to the child in the Personal Child Health Record (or ‘Red Book’) is instrumental in the safeguarding of young girls.
Doctors should be aware that they may be dealing with potential child abuse and making an automatic referral to children’s social care or the local multi-agency safeguarding hub (MASH) does not breech patient confidentiality but provides added protection to the child. Such preventive measures are also part of the life-course approach. Other times when doctors should be vigilant include when girls present for their inoculations (childhood diseases, booster, HPV and travelling vaccinations), routine health checks or if they seek sexual healthcare.
The Committee has noted the double standard in the way FGM and female genital cosmetic surgery (FCGS) are regarded by society and the law. The RCOG agrees with the principle that FGCS should not be performed in women under 18 years of age, unless clinically indicated. This is the view of the RCOG and the British Society of Paediatric and Adolescent Gynaecology (BritSPAG).
Finally, the Committee has advised that the Government amends the FGM Act (2003) to include reinfibulation. The International Federation of Gynecology and Obstetrics (FIGO) has stressed that there are no known medical benefits to the practice and the reproductive and psychological harms to women who have had been reinfibulated are well catalogued by the World Health Organization (WHO). The Government should be made aware of the RCOG’s clinical guidelines on the repair of the deinfibulated vagina following vaginal delivery.
To view the press release by the Home Affairs Committee, click here
Intercollegiate Group response: Unite/Community Practitioners' and Health Visitors' Association (CPHVA)