On Wednesday 5th February 2025, Savera UK hosted its second Healthcare & FGM event, this time focusing on improving interventions for survivors and those at risk of female genital mutilation (FGM).
The event took place to mark the International Day of Zero Tolerance for Female Genital Mutilation, which takes place annually on 6th February and acts as a call to action to protect human rights and end FGM for good.
Chaired by Savera UK board member, Dr Susan Waigwa, the event began with a brief introduction to FGM, its roots, impact and the law, delivered by Savera UK CEO and Founder, Afrah Qassim.
Highlighting its impact in the UK and around the world, Afrah shared a range of key estimates with professionals.
- More than 230 million girls and women alive today have been subjected to FGM*
- More than 140,000 FGM survivors living in England and Wales**
- 60,000 girls aged 0-14 born in the UK may be at risk of being subjected to FGM
- 46 cases of FGM referred to Savera UK between April 22 and Jan 25
Before explaining the four different types of FGM, and the laws that exist to help prevent them, Afrah dispelled common myths surrounding FGM, stating that it is not a part of any culture or tradition, nor a religious practice, but instead a violation of human rights.
She also explained how despite being considered a “non-western” procedure, historically the practice of FGM was established by Isaac Baker Brown in 1860s in London, who made the surgical removal of the clitoris an acceptable treatment for a wide range of conditions including “hysteria” and mental illness.
Method of controlling women
FGM survivor, Khatra Paterson, reflected Afrah’s statement that FGM is a violation of human rights, despite it being presented to women and girls like her as a deep-rooted tradition and “rite of passage” as a woman.
Khatra said: “You are told that it’s a rite of passage, but it is a violation of human rights and a method of controlling women. All of the women in my family have been subjected to FGM. I knew it was wrong, but you are so conflicted. We were told that people criticised the practice because they ‘don’t understand our culture’. We were told not to talk about it to anyone and it was shrouded in shame.”
As a survivor and healthcare professional, Khatra highlighted the gap between the two, with many healthcare professionals finding it difficult to broach the subject, and also unsure of how to implement policy relating to FGM.
Discussing policy, Khatra asked attendees to respond to the following question: “If a patient was a pregnant woman/new mum to girl(s) and had been subjected to FGM, would you refer the mother to social services?”
Fifty-six percent responded ‘Yes’, 18% said no and a quarter (25%) said they were not sure.
Mandatory FGM Reporting
The Mandatory Reporting of FGM was introduced in 2015, and under its obligations healthcare professionals would be required to report a pregnant woman or new mum of girls if she had been subjected to FGM.
The Mandatory Reporting Duty was a new law introduced in 2015 by the Serious Crime Act which states that if a girl under 18 is identified with FGM then she has to be referred to the police and social services. Pregnant women with FGM are not automatically all referred to social services, but all pregnant women with FGM (that are over 18) are required to have a safeguarding assessment conducted by a healthcare professional.
Khatra said: “This didn’t sit well with me as a health visitor and an FGM survivor, as the assumption is that women who have been cut are more likely to cut their daughters. There is no discussion with the women themselves to ascertain if there is risk, or to help them understand why they are being reported.
“There is no balance between autonomy and protection. Women’s ability to be a parent is being defined by something they are victims of and mandatory reporting, as it stands, perpetuates damaging stigmas and disempowers them.
“Managing safeguarding risks is important, but dialogue is vital. Healthcare professionals should consult and find out more information so they can take appropriate action and give the right support. It can’t just be a box-ticking exercise.”
Juliet Albert, the co-lead for ACERS-UK (Access to Clitoral reconstruction surgery & Emotional support within a Research framework for FGM Survivors) shared Khatra’s point that there is a critical need for more conversations and more supportive healthcare policies to help FGM survivors.
Before handing over to Juliet for her presentation Dr Waigwa provided a short summary of the services available to FGM survivors in the UK, with around 25 specialist clinics identified. About ten were for pregnant women only, and about 15 clinics accepted non-pregnant women In many cases women often travel hours to be seen.
Further to this, Juliet highlighted that of all the specialist clinics, only three offered psychosexual therapy. In a PhD study of UK treatments for FGM survivors, it was found that Deinfibulation (opening surgery for women with Type 3 FGM) was usually available, trauma therapy was sometimes available, but psychosexual therapy was rarely available and there were no options for reconstruction surgery (surgery to restore genital appearance), which some women seek to address genital pain, difficulty enjoying sex and body image concerns.
She explained how ACERS-UK’s objective was to establish an NHS National Centre of Excellence offering reconstruction surgery and psychosexual therapy for FGM survivors, within a research setting, supported by robust clinical trials.
Patient-centred care
Despite the WHO stating in 2016 that there was not enough evidence to recommend reconstruction surgery, women increasingly request it when attending FGM specialist services. Moreover, in the UK women have private access to “designer vagina” surgery, vulval reconstruction post cancer and male to female gender reassignment surgery.
Juliet said: “Delivering patient-centred care means responding to patients’ request for this treatment option and improving women’s physical and psychosexual health will improve outcomes for families and communities affected by FGM.”
ACERS-UK are working towards the establishment of a specialist service by listening to the needs of FGM survivors and finding out what they want, reviewing existing evidence and establishing educational and informational resources. They are also applying for funding for a clinical trial and service set up and have partnered with Oxford University Surgical Trials Unit, exploring different techniques for reconstruction surgery.
A health inequality
The importance of ACERS-UK’s work being delivered in a research setting is that it will contribute to the currently limited evidence base, protect women through the implementation of strict ethical guidelines, be transparent and open to close scrutiny and attract funding.
Integrating reconstruction with access to psychosexual therapy is also important as it may improve outcomes for those accessing reconstruction for sexual function, or women who ask for reconstruction may find they no longer want it after psychosexual therapy.
Juliet said: “It’s important to note that not all women with FGM would want or benefit from reconstruction surgery and/or psychosexual therapy – but lack of access to this is a health inequality, it is unethical and is a social injustice. This is what we are trying to address.”
As well as highlighting funding bids currently being compiled by ACERS-UK, Juliet highlighted a petition started by FGM survivor and campaigner Shamsa Sharawe for the government to fund reconstruction surgery and psychosexual therapy on the NHS, which you can read and sign here.
Improving understanding of FGM
Following the event, Afrah said: “We were so grateful to be joined by hundreds of professionals at our online event, to learn and better understand how we can help survivors and those at risk of FGM.
“It is vital that healthcare professionals recognise FGM and any other harmful practices as a human rights violation and understand the life-long physical and psychological impacts these can have.
“We cannot be blindsided by culture when safeguarding is a factor and we need to ensure we are equipped to have critical and appropriate conversations, as well as remaining committed to listening to survivors, being open to improve understanding, and be willing to learn at all times.”
For information about ACERS-UK click here.
To learn more about Savera UK’s training, visit: https://www.saverauk.co.uk/what-we-do/commission-training/
*Source: https://www.who.int/en/news-room/fact-sheets/detail/female-genital-mutilation
**Source: Macfarlane A, Dorkenoo E. Female Genital Mutilation in England and Wales: Updated statistical estimates of the numbers of affected women living in England and Wales and girls at risk Interim report on provisional estimates. 2014.
