Communities must be listened to and grassroots expertise enlisted if we are to end this practice

Last week on the UN International Day of Zero Tolerance for Female Genital Mutilation (FGM), the international community once again condemned this practice. Who would disagree that FGM is a great harm—both an act of violence against women and a violation of human rights?

This year politicians acknowledged the day with public renewals of their commitment to achieving the Sustainable Development Goal to eliminate the practice by 2030.

This drive towards ending FGM is commonly framed in a penal context, with the prosecution of cutters and parents sending an unequivocal message. Yet while criminal laws against this traditional practice already exist in over 24 countries, these have been met with few prosecutions and little evidence of the practice declining. This is perhaps unsurprising. FGM is deeply embedded in culture; criminalisation and legal reform will not be enough to tackle this practice.

Local chiefs, religious leaders, and community elders have far greater influence than any law. FGM is culturally, and often religiously, important to the people who seek to continue it. Legal reform may demonstrate political will, but when it’s made in response to pressure from the international community, it may carry with it an unacceptable whiff of cultural imperialism. This disregard for indigenous cultural beliefs risks alienating those who would practice it and entrenches beliefs that FGM should continue.

We need to move the narrative beyond prosecution. There must be commitment both to meaningful engagement with communities and robust enlisting of grassroots expertise. We need to be humble enough to realise that people living within those communities are well placed to challenge cultural practices such as FGM. They are best placed to tell policy makers what will and won’t work and to inform the law. We also need to recognise that FGM will not end until other inequalities in health, education, and reproductive rights are also addressed.

Now is the time to reflect on what is happening on our own shores to tackle FGM in diaspora communities. The lack of prosecutions for FGM under the 2003 FGM Act makes for easy headlines and renewed wringing of hands that we are abjectly failing to tackle this in the UK. But talk to women from these communities in the UK and they will say that this law acts as a deterrent, and gives a legal stronghold to reject calls from back home to have a girl cut.

We may be going too far in a drive to secure prosecution by passing additional laws, including one recently that mandates doctors (and other regulated professionals) report any under 18s with FGM directly to the police. This legislation was well intentioned. The more investigations, the greater the chance of (finally) finding a case that can be successfully prosecuted.  

This legislation was, however, passed after an inadequate consultation process. There have been numerous unintended consequences that policy makers are reluctant to hear. For example, with only a few exceptions, mandatory reports to date have related to children who underwent FGM before arriving in the UK. Furthermore, this mandated disclosure of FGM in a health consultation demands a breach of patient confidentiality without consent of the child or parent. It offers no further benefits over safeguarding regulations that had already been established.  

This disproportionate response, which involves police, seriously impacts on the individual, her family, and her community.  Moreover, it attacks trust—the very cornerstone of the doctor-patient relationship. Communities are already indicating that girls with FGM are deterred from seeking help for complications, or even engaging with health professionals on unrelated matters, for fear that their FGM will be “outed” and police will get involved.   

With the passing of another UN International Day of Zero Tolerance, we need to honestly appraise where the fight to end FGM is now—locally and  internationally. We need to be well informed and move beyond hastily implementing legislation. We need to recognise the tremendous work going on in communities, health, education, police, and social care towards ending FGM. We need to work to rebuild trust and engage with communities to find the solutions.  Above all, we need to remember that slow progress is still progress.  

Brenda Kelly is a consultant obstetrician at Oxford University Hospitals NHS Foundation Trust. She is also clinical lead of the Oxford Rose Clinic, a specialist service for women and girls with FGM, and patron of the charity Oxford Against Cutting.

Competing interests: I have given expert opinion on the subject of FGM as both pro bono and paid work.

Filsan Ali is director of the Midaye Somali Development Network. Midaye currently delivers FGM community awareness and engagement activities in Kensington and Chelsea, Hammersmith and Fulham, Westminster, Brent, Wandsworth, and Birmingham. The network also provides a community health advocacy service at the FGM clinics for Imperial College Healthcare NHS Trust, and Chelsea and Westminster Hospital NHS Foundation Trust.

Competing interests: I am the director of an organisation that receives funding to deliver services around community awareness of FGM.