Understanding Female Genital Mutilation

Introduction

Female genital mutilation (FGM) is defined by World Health Organization (WHO, 2016) as the total or partial removal of the external female genital parts for non-therapeutic purposes or the injury of the female genitalia for non-health reasons. However, the World Health Organization classification indicates that FGM can be classified into four major categories namely Type (i), (ii), (iii), and (iv). Type (i) involves the removal of the prepuce with or without the removal of the part that covers the clitoris. Type (ii) involves the removal of the clitoris with or without total removal of labia minora. Type (iii) involves the partial or entire removal of the external genitalia and narrowing of the vaginal opening, while type (iv) entails the various practices such as pricking, incising the labia and/or the clitoris or cutting the vagina to cause bleeding or to tighten it (WHO, 2016). Against this backdrop, Dorkenoo et al (2007) indicate that type iii FGM accounts for approximately 15% of FGM practices in Africa while types i and ii accounts for 80%. Yet, little is known about the practice these types of FGM in the UK.

A lot of studies have attempted to explore the reason why communities conduct FGM. For instance, African United against Child Abuse (AFRUCA, 2015) claims that FGM is predominantly practiced with reasons grounded on women’s fertility and sexual reproductive capacity control. However, various communities have various reasons for practicing FGM, some common ones being: the need to reduce women’s and girls’ sexual desire, for aesthetic reasons, to enhance chastity and virginity, and to promote girl’s ability to please their husbands when they finally get married (Macfarlane & Dorkenoo, 2015). Nonetheless, in some ethnicities, FGM is practiced as a rite of passage from childhood to adulthood and thus becomes an important procedure that girls have to undergo before they are called ‘women’. Currently, female genital mutilation (FGM) is categorized by the United Nations as a violation of human rights (Berg et al, 2010). Besides, the UK government legislation, under the UK children Act considers it an illegal activity. However, UNICEF (2016) recognizes that FGM is still being undertaken among minority communities in the UK, and in fact, this has made FGM a focus of educational campaigns among these ethnic communities for nearly two decades now (United Nations Children’s Fund, 2013). However, despite the acknowledgment of its practice in the UK, there is a dearth of research evidence highlighting the social and psychological impacts of FGM particularly among the Black, Asian and Minority (BAME) communities in the UK. Yet, lack of such information contributes to the marginalization of the issue, especially considering that the BAME community already face other socio-economic marginalization (Gerry et al, 2016).

Consequently, there is an urgent need for an in-depth inquiry of the social and psychological impacts of FGM to this unique population in order to enhance the comprehensive development of solutions to the issue. Girl Summit (2014) also argues that an inquiry into the social and psychological impacts of FGM among BAME communities in the UK would enable effective planning and implementation of a nationwide strategy that aims at preventing and eliminating FGM not only among the BAME community but also among other communities in the UK. Such information would form the basis upon which various person-centred interventions and action plans are developed by the UK authorities in creating support services for both victims and potential victims. The proposed study, therefore, seeks to provide such information by exploring the social and psychological impacts of FGM among the BAME communities in the UK.

FGM in the UK

From a global perspective, it is estimated that at least 100 to 140 million women in Africa and Asia have undergone FGM, while at least 3 million women are mutilated annually, with some cases also reported in the larger Middle East (Dorkenoo et al, 2007). However, Department of Health London (2015) observes that due to the increase in migration into Europe, there has been an increase in FGM practice in European countries such as Australia, Canada, New Zealand, and the United States. In the UK, reports by the Department of Health London (2015) indicate that FGM is a custom that still exists not just in England but in Scotland. Besides, reports by Gulland (2017) indicate that FGM is even conducted in expensive private hospitals in Birmingham, London, and Bristol – areas where ethnic communities that originally practice FGM reside. Such communities continue with their practice of FGM mainly because they tend not to leave their culture behind.

Statistically, it was estimated in 2011 that in the UK, 103,000 women living in England and Wales aged 15-49 years old have undergone FGM (Macfarlane et al, 2015). Nonetheless, according to Dixon et al (2018), the prevalence of FGM in England and Wales is estimated to be 4.8 girls in every 1000 population (Macfarlane et al, 2015). Furthermore, whereas there are wide variations of prevalence, London has the highest rate of prevalence, while other regions such as Bristol, Manchester, Slough, and Birmingham are also characterised by high rates (Macfarlane et al, 2015). There is a paucity of research of FGM in the UK, especially those highlighting the BAME communities. However, research by AFRUCA (2015) conducted a study on FGM among the African communities in the UK and found a gap in the provision of support and education for FGM victims and stressed the need for men’s involvement in the fight against FGM. They also found a culture of silence among communities in the UK where community members fail to admit that they know anyone performing FGM, yet they know where these services are delivered (AFRUCA, 2015). The proposed study will highlight in some of the social issues related to the community and how they impact on the fight against FGM among the BAME community in the UK.

Generally, there are varied reports on the age from which girls undergo FGM in the UK. However, Dixon (2015) indicates that most cases involve girls who are below the legal age of majority. Even so, each community has its own prescribed age of practice, and some carry it out at adolescence, at childhood, or at adulthood. However, according to Norman et al (2009), experts now agree that the age at which FGM is carried out is decreasing.

Statement of the Problem

The reason why FGM is considered a human rights issue is that in the absence of any medical justification, it violates the individual’s personal integrity and inhibits them from achieving the highest level of mental and physical health (Berg et al, 2010). Thus, it is considered by WHO and other global health organizations as a form of discrimination and violence. Apart from that, FGM is prohibited because of the health risks it exposes its victims, some of the risks being severely disabling (Berg et al, 2010). For instance, the Department of Health London (2015) complains that type (iii) FGM exposes girls to serious long-term complications especially when a flap of skin is stitched to cover the vaginal opening. The flap causes a mechanical vaginal barrier to menstruation, urination, delivery and sexual intercourse (Girl Summit, 2014).

In a recent study by WHO (2016), it was found that women who had undergone FGM were associated with more risk of health complications such as prenatal death, infant resuscitation and a higher risk of caesarean section compared to those who had not undergone FGM. In another study by Bebbington et al (2011), it was found that women who had undergone FGM were more predisposed to the risk of being infected with Herpes Simplex Virus-2. But existing research by Lockat, (2004) shows that the physical health impacts of FGM can also lead to social and psychological effects. However, despite concerns raised over these effects by various healthcare bodies in the UK including the National Health Service (NHS), a few attention has been given to these psychological and social impacts especially among the BAME community, a phenomenon that has been highlighted by several pieces of research (e.g. Global Summit to End Sexual Violence in Conflict and Global Summit) to have implications for future research.

Despite the existing evidence (e.g. Bebbington et al 2011) that FGM causes childhood trauma as well as other social and psychological well-being, there is little evidence on the psychological and social impacts among the BAME community in the UK, and this makes the issue be given little practice and policy attention. Furthermore, while existing pieces of evidence (e.g. Mulongo et al 2014) highlight the emotional and psychological problems associated with FGM, there is a paucity of focus on the social and psychological consequences in the UK context, and within the context of the UK.s BAME community. Yet, a lack of knowledge on the social and psychological impacts of FGM makes it difficult to put into context the norms, values, and cosmologies within which victims and survivors make sense of their experiences (Department of Health London, 2015). Ultimately, according to Girl Summit (2014), the overemphasis on physical impacts of FGM impedes the understanding of its impacts from a social and psychological perspective and this makes it nearly impossible to develop social and psychological solutions to the menace among the BAME community in the UK.

Research Aim

Therefore, the main aim of this study is to explore the social and psychological impacts of FGM among the UK’s ethnic minorities.

Research Objectives

i. To identify the social and psychological impacts of FGM among minority ethnic communities in the UK

ii. To identify the risk factors exposing women among minority ethnic communities to FGM in the UK

iii. To identify effective strategies for eliminating FGM among minority ethnic communities in the UK

Research Questions

i. What are the social and psychological impacts of FGM among minority ethnic communities in the UK?

ii. What are the factors exposing women among minority ethnic communities to FGM in the UK?

iii. What are the effective strategies for eliminating FGM among minority ethnic communities in the UK?

Justification of the Study

There is no doubt that FGM is still alive and prevalent in the UK. Existing evidence also reveals that the BAME communities in the UK are practicing FGM at an alarming rate. However, apart from the physical health impacts of FGM on survivors, the menace leaves an indelible social and psychological mark in the lives of the survivors. The proposed study is justified because it will throw light on the issue of FGM and its practice among the BAME community in the UK. Comparable to Africa and other regions, there is generally a little research attention to the issue of FGM in the UK, and this arguably contributes little attention given to FGM among the marginalized minority ethnic communities in the UK. This study seeks to venture into this grey area, to identify the key social and psychological issues related to FGM among the BAME community, the risk factors that expose girls in these communities to FGM, and the possible solutions of addressing FGM among them. From the onset, the findings of this study will inform policy development in the UK regarding FGM from a contemporary perspective. Besides, it will help in developing effective solutions for the practice of FGM among young innocent girls who are currently undergoing not only physical but also mental and emotional torture due to FGM. Ultimately, the study will contribute to already existing knowledge base of the social and psychological impacts of FGM, thereby transforming the knowledge capabilities of students and practitioners who would like to conduct further research in this topic area.

Research Methodology

This section of the paper seeks to highlight the research methods that the proposed study will use to examine the social and psychological impacts of female genital mutilation among the ethnic minority communities in the United Kingdom.

The Narrative Review of Previous Studies

As the Descombe (2010) claims, a narrative review of previous studies involves a systematic identification, selection, and inclusion of previous study material to undertake secondary research on a given phenomenon. The idea of systematic literature search methods borrowed from a methodical literature review technique considering the reliability of intended literature, emphasis and relevance of the source exists. The study embraces the methodology of narrative literature review to investigate the social and psychological impacts of female genital mutilation among ethnic minority communities in the UK.

Search Approaches

The study intends to engage the use of a systematic search of literature review looking into the online databases and search engines like CIHAHL, JUSTOR, EBSCO, Web of Science, PubMed to identify and select the literature materials. The search engines are selected based on their relevance to political science, Law and medical science. The analysis was limited to articles whose contents regarding social and psychological impacts of female genital mutilation among ethnic minority communities in the UK published in English.

Search Terms

The study will include keywords like ‘female circumcision’ to includes various semantic field including (female genital mutilation, female genital cutting). ‘Clitoridectomy,’ ‘social and psychological impacts of FGM,’ ‘ethnic minority communities in the UK are practicing FGM,’ ‘social, psychological effects of immigrants.’ ‘Social and psychological effects of FGM.’ The search terms are expected to provide a comprehensive search of literature material (World Health Organization, 2015). The Boolean operators such as ‘AND’ and ‘OR’ will also be used to organized the search terms to facilitate specificity and sensitivity of the literature search process.

Exclusion and Inclusion Criteria

The primary research resulted in 2,570 reference items, after removing the duplicates, 1, 250 questions remain. An independent manual screening by NBK and EKM was used to exclude all papers contains women who come from ethnic majority communities in the United Kingdom, and those who come outside the UK and the document focuses on the legislative and medical aspect of the practice (Berg, & Denision, 2012). Of the 547 remaining references items, those without an abstract, books, and those articles that did not discuss the social and psychological impact of female genital mutilation among ethnic minority communities in the UK were then excluded independently from the study . According to Descombe (2010), the exclusion and inclusion criteria are vital in demonstrating the scope and relevance of the literary materials. The study, therefore, will include studies written in English to allow easy reading and understanding of the information. Also, only academic papers are included to ensure the information retrieved is relevant and specific to the research question. Full-text materials were also added to allow identification of data analysis.

Data Extraction and Analysis

The list of identified items was organized and analyzed in an excel database into different columns that capture publication year, affiliation country of the first author, journal type, study design, study setting, and medical results, epidemiological results, social, economic results. Patterning to the category type issues of the journal, the references will be classified according to care journals, mixed journals, biomedical, public health journal as well as social sciences journal. The documents will then be separated between cross-sectional, qualitative studies including interviews, social analysis including anthropological studies, legal and social-political (Equality Now and City University London, 2014). Other aspects may include case series, economic studies, and systematic reviews. The study setting refers to the geographical region, population type and the concentration of the study. In the circumstance where the results and discussion contains all women psychologically suffered from female genital mutilation in general but no specific country, the specification is the United Kingdom. The articles will then be finally classified based on the main research topic. Special attention will be given to the references focusing on the social and psychological impact of the female genital mutilation among ethnic minority communities in the UK.

Additionally, the generation of second women from the minority ethnic communities in the United Kingdom not identified. The study based on the probability of having female genital mutilation purely on the birth country does not take in to account the ways, which practice affects social and psychology of women from minority communities in the United Kingdom. Facts reveal that there is a decline in the FGM with more women migrated to the West as opposed to particular countries of origin or birth (Myhill, & Johnson, 2016). The estimates are likely to effects the women from the minority communities where FGM practiced who left their countries of birth at a tender age.

Ethical Consideration

Ethical issues in relation to studies being reviewed

The researcher will ensure that all the data captured used in a manner that does not cause damage to reputation or harm the original author. Nonetheless, it is important to note that data on the social and psychological impact of female genital mutilation (FGM) among ethnic minority communities in Britain is scarce. However, in an ethical spirit, the retrieved data will be used conservatively to achieve the research objectives. However, the researcher will also take note that Census data is prone to underestimation numbers in some groups deemed reluctant to take part in the census as looming resistance concerned are taken care of or conventions. The researcher will be keen to note these underestimations. The researcher will be keen to identify how the selected papers will address the confidentiality issues at the data collection time. In doing so, the researcher will ensure whether the participants were assured of their confidentiality, and whether their personal information was were kept confidential. Furthermore, the researcher will be keen to identify whether the authors of the respective studies presented the confidentiality agreements to their participants at the beginning of the data collection process — and whether they obtained an informed consent from their participants. The researcher will also be concerned about the validity of the collected data. This will be done by ensuring that the reviewed literature does not address other communities other than the ethnic minority in the UK.

The collected data may vary in terms of identifying information in it. Retrieved data will have any identifying information; the researcher will have to seek permission and review from the ethical board. However, if the data will not have any identifying information, the researcher will not have to seek a review by the ethical board. In the latter case, the researcher will commit to explain to the ethical board why the data contains identifying information and why the information could not be avoided as part of the data used to answer the research questions; while explaining how the participant’s confidentiality and privacy will be protected. Because the researcher also intends to use books and journals freely available in the internet, there may be a need for permission for further use. However, in such a scenario, the researcher will have to acknowledge the authors of these materials. In the case where the used data is not freely available, the researcher will have to explicitly write a request for permission letter as part of the application for ethical clearance. There are other issues pertaining to secondary data that will have to be given some ethical consideration. For instance, the researcher will ensure that the obtained data is adequate, relevant but not excessive. Besides, it may happen that during the data analysis, the original data might not be used in the answering of current research question. Hence, the researcher will carefully evaluate the data based on certain criteria such as period of data collection, method of data collection, accuracy and purpose for which the data was collected. Nonetheless, any collected data will be kept safe from any unauthorized access: soft copy data will be kept in encrypted USB drives while any hard copy data will be locked up in safe cabinets.

The researcher will also ensure that any further analysis of the collected data is done ethically. For instance, where there is a provision by the authors that further analysis of the data should be done with special consent from the author, the researcher will draft a consent letter and present it to the ethical committee for ethical review.

Conclusion

FGM is prevalence on the minority communities in the UK and more so low income and middle-income families. The practice perceived as child abuse and gross violation of children and women’s rights, which considered unlawful in the United Kingdom. It is severe health consequences especially in terms of sexual, mental health and childbirth. The prevalence among children varies from a state to state, the proposed study seeks to address these issues by revealing various pieces of evidence from exiting studies and presenting them in a manner answers the research question.

References

Voices of the Community: Exploring Female Genital Mutilation in the African Community across Greater Manchester. AFRUCA; 2015.

Dorkenoo E, Morison L, Alison M. A Statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales, Summary Report; Foundation for Women’s Health, Research and Development. 2007 (FORWARD).

World Health Organization . WHO guidelines on the management of health complications from female genital mutilation. Geneva, Switzerland: World Health Organization; 2016.

Berg RC, Denison E, Fretheim A. Psychological, social and sexual consequences of female genital mutilation/cutting (FGM/C): a systematic review on quantitative studies. Report from Kunnskapssenteret nr 13-2010. Oslo: Nasjonalt kunnskapssenter for helsetjenesten; 2010.

Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change. New York: United Nations Children’s Fund; 2013.

Macfarlane A, Dorkenoo E. Prevalence of Female Genital Mutilation in England and Wales: National and local estimates. London: City University and Equality Now; 2015.

“Between Two Cultures” a rapid PEER study Exploring Migrant Community’s Views on Female Genital Mutilation in Essex and Norfolk UK, Barnardos and FORWARD March 2016.

Department of Health . Safeguarding women and girls at risk of FGM - GOV.UK. London: The Stationary Office; 2017.

Gerry F, Rowland A, Fowles S, et al. Failure to evaluate introduction of female genital mutilation mandatory reporting. Arch Dis Child. 2016.

Bewley S, Kelly B, Darke K, Erskine K, Gerada C, Lohr P, de Zulueta P. Mandatory submission of patient identifiable information to third parties: FGM now, what next? BMJ. 2015.

Dixon S, Agha K, Ali F, El-Hindi L, Kelly B, Locock L, Otoo-Oyortey N, Penny S, Plugge E, Hinton L. Female genital mutilation in the UK- where are we, where do we go next? Involving communities in setting the research agenda. Res Involv Engagem. 2018 Sep 17;4:29. doi: 10.1186/s40900-018-0103-5. PubMed PMID: 30237901; PubMed Central PMCID: PMC6139895.

Mathers N, Rymer J. Mandatory reporting of female genital mutilation by healthcare professionals. Br J Gen Pract. 2015;65(638):450–451.

Norman K, Hemmings J, Hussein E, Otoo-Oyortey N. July 2009 FGM is always with us Experiences, Perceptions and Beliefs of Women Affected by Female Genital Mutilation in London Results from a PEER Study.