1. Learning from North African women’s experiences of Female Genital Mutilation/Cutting (FGM/C) Judith Ormrod

2.  FGM/C comprises all procedures involving partial or total removal of the external genitalia or other injury to the female genital organs for non-medical reasons.  The WHO classify FGM/C into four types, the most extreme of which (Type 3) involves narrowing of the vaginal orifice.  Reasons for FGM/C  Legal aspects - Female Genital Mutilation Act (2003) amended by section 73 of the Serious Crime Act 2015. Definition

3.  Globally 200 Million women and girls have undergone FGM/C and a further 3 million girls undergo FGM/C every year (UNICEF 2016)  Most women affected live in 28 African countries but also in the Middle East and Asia.  The highest prevalence rates of 90% or more are found in Somalia, Sudan, Djibouti, Egypt, Guinea and Sierra Leone. Background

5.  Due to an increase in international migration FGM/C is practiced amongst migrant communities in Europe and the UK.  Macfarlane & Dorkenou (2014) suggest approximately 60 000 girls from birth -14 years were born in England and Wales to mothers who have undergone FGM/C.  103 000 women aged 15 - 49 and approximately 24 000 women aged 50 or above who have migrated to the UK and are living with the consequences of FGM/C.  Manchester is a large vibrant multicultural city and the 2011 census highlights people born in Nigeria and Somalia as being amongst the top 10 countries of birth (ONS,2012) FGM/C in the UK

6.  Short term – distress, haemorrhage, urinary retention, genital swelling, infections (Hepatitis B and C, HIV ) and death.  Long term – urinary tract complications, psychological difficulties, menstrual problems, genital infection and pelvic inflammatory disease, sexual difficulties, infertility, obstetric complications, HIV and hepatitis B infections. Consequences of FGM/C

7.  North African women's experiences of living with FGM/C and NHS care.  Gatekeepers - support from AFRUCA and Bolton Solidarity Community Association.  Small qualitative study involving 10 women from Somalian, Nigerian and Sierra Leonean backgrounds.  Involvement with NHS care  Experiences of living with FGM/C. The project

8.  Health concerns  Consequences of living with FGM/C  Communication difficulties Three main themes

9.  Issues which women living with FGM/C are comfortable accessing assistance from the NHS  Issues which women living with FGM/C are uncomfortable / reluctant accessing help from the NHS Health concerns

10.  Many women may not be aware they have been cut prior to involvement with midwifery / obstetric care.  Psycho-sexual consequences.  Emotional and psychological consequences.  Physical consequences. Consequences of living with FGM/C

11.  Health care practitioner not knowing about FGM/C.  Health care practitioner’s reaction to women living with FGM/C.  Sensitive use of interpreters.  Health care practitioner being aware of the setting, need for privacy, empathy and understanding of potential issues Communication difficulties and avoidance

12.  Ongoing challenges for many women throughout the life- span  Difficulties for those women who may not be ‘legal’ and fear of accessing NHS services  Supporting children from influence of extended family  Lack of services  Language and translator issues  Being aware we have students and colleagues who are from practicing communities  Community involvement is paramount Take home points

13.  Berg RC Denison E (2013) A tradition in transition: factors perpetuating and hindering the continuance of Female Genital Mutilation / Cutting (FGM/C) Summarized in a Systematic Review. Health Care for Women International, 34;10,837 -859  Department of Health (2015) Female Genital Mutilation Risk and Safeguarding – Guidance for professionals  Macfarlane A Dorkenou E (2014)Female Genital Mutilation in England and Wales: Updated statistical estimates of the number of affected women living in England And Wales and girls at risk. Interim report on provisional estimates. City University and Equality Now.  Mulongo P, McAndrews S, Hollins Martin S (2014) Crossing borders: Discussing the evidence relating to the mental health needs of women exposed to female genital mutilation. International Journal of Mental Health Nursing 23,296 -305  Reisel D, Creighton S M (2014) Long term health consequences of Female Genital Mutilation (FGM). Maturitas http://dx.org/10.1016/j.maturitas.2014.10.009http://dx.org/10.1016/j.maturitas.2014.10.009  RCM,RCN,RCOG, Equality Now, UNITE(2013) Tackling FGM in the UK: Intercollegiate Recommendations for Identifying, recording, and reporting. London: Royal College of Midwives. References

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