Female Genital Mutilation

Female genital mutilation, or FGM, is a violation of the human rights of girls and women. This practice isn’t driven by any medical imperative, but is defined by the World Health Organisation as all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons.

While the horror of FGM remains a real prospect for many children and young women, a study published last month in BMJ Global Health has found new evidence that the rates of female genital mutilation have fallen dramatically. According to this study, the proportion of children in North Africa who have been victims of FGM has fallen from 57.7% in 1990 to 14.1% in 2015. At the same time, the number of child victims in West Africa has also seen a significant decrease from 73.6% of the child population in 1996 to 25.4% in 2017.

Despite this welcome news, currently more than 200 million girls and women alive today have undergone the procedure. Earlier this year the United Nations Population Fund predicted that population growth in communities that carry out the practice means that the number of female victims of this practice could rise to 4.6 million each year by 2030.

While the huge global effort to mobilise support for the education of women in Africa and other affected areas has clearly started to pay dividends, there is still much that can be done outside these communities to advance the human rights agenda in this area.

That’s why our own Faculty of Travel Medicine, led by its new Dean Jane Chiodini, has developed a new tool to better equip healthcare professionals in the UK and beyond in the struggle to end this practice. Thanks to the College’s new free online course, healthcare professionals who carry out pre-travel consultations will be better equipped to deal with issues around FGM.
This accredited online learning package has been produced by subject experts in the College’s Travel Medicine Faculty and is being actively promoted to healthcare professionals in our College and beyond. The course aims to assist nurses, pharmacists and doctors in overcoming the potential barriers there may be to raising the topic in a travel medicine consultation, and gives practical support to those who find themselves in this situation.

The module was written to help practitioners reflect on what specific issues need to be addressed in these consultations in order to meet their professional and legal obligations, while recognising that this can often be a difficult and sensitive subject to raise with patients in this environment.

For example, existing guidance produced by the Royal College of Nursing in association with the College states that it’s best practice for travel health practitioners to include a pre-travel risk assessment. This should form the basis of any subsequent decisions, advice and prophylactic treatment given to each patient. The guidance recommends that a question about FGM should be included in this questionnaire.

In particular, healthcare workers should be on the lookout for some key indicators that FGM may be planned. For example, families planning a long time away on holiday, especially during the summer may be at increased risk, as are girls presenting for travel vaccinations to countries with high FGM prevalence. Girls who raise the issue of a special ceremony which may take place while on holiday are also at risk.

It’s particularly important that practitioners keep up to date with best practice given the changing legal positon around FGM. Since October 2015, under the Serious Crime Act, healthcare professionals in England and Wales have a mandatory professional duty to report to the police if a girl discloses to them that she has had FGM, or if it is identified through the delivery of routine care. There is also a system of mandatory data recording of FGM in place to allow NHS England to monitor this issue at both a local and national level. The Scottish Government are currently holding a consultation exercise on how they should update their approach to FGM, which includes questions on whether they should mirror these approaches.

FGM is a dangerous, harmful practice. The World Health Organization, UNICEF and the UK and Scottish governments are all committed to ending this abhorrent practice in a generation.

If we’re to be successful in our aim to eradicate FGM, professionals working within travel health will play a leading role. It’s vital that we ensure the safeguarding of girls who may be at risk of FGM, especially through travel abroad. Through the development of this new resource, our College remains committed to playing our part in these worldwide efforts.

Launching this new online tool, Jane Chiodini, Dean, Faculty of Travel Medicine said: “FGM is child abuse. It is illegal to take girls under the age of 18 who are British nationals or permanent residents of the UK abroad for FGM, whether or not the practice is lawful in that country. “In addition, if a practitioner suspects a child is at risk, we’re obliged to take action to support them.

“But as a nurse who is a specialist in this area, I know that many of my colleagues who deliver travel health services don’t always have experience of identifying or dealing with this situation effectively. They may also lack the confidence to raise the topic of FGM in a travel consultation, especially when this takes place in a time-limited appointment. When this happens, the opportunity to prevent this horrific practice is tragically missed.
“That’s why our College has launched this new free to access e-learning module, developed by subject experts in our Faculty of Travel Medicine. Our free course looks at some of the perceived barriers to raising the topic, and explores the solutions which could be used to make practitioners more confident in dealing with this situation. This is the first piece of supportive e-learning education developed specifically for travel medicine practitioners, and as such is a great tool in the fight to combat FGM across the globe.”

In addition to seeking ways to directly support healthcare workers through our new module, the College has also used this opportunity to engage with other organisations and individuals with an interest in this area to combat the issue.

“We’ve already had contact with Members of Parliament, the House of Lords and the Scottish Parliament who are keen to hear more about the practical steps we can take here in the UK to combat FGM. In addition, as a result of our work to promote this new resource, we’re now also looking at new opportunities to work with a national charity in Scotland to make sure that we can get this training tool to everyone who needs it.
“Eradicating FGM will be a huge task, but we’re committed to playing our part as a College to ensure that no women or children are subjected to this distressing and unnecessary procedure.”

Go here to download the new online tool.

This article is taken from the Winter edition of voice, our College membership magazine. You can download your copy now.

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