Understanding FGM in Birmingham

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Transcript Understanding FGM in Birmingham

Understanding FGM in
Nasheima Sheikh
Khadija Jaamac
• Provide four refuges in Birmingham & Solihull
• Provide Outreach support in the community &
work with high risk women
• Support women going through Courts and with
• Therapeutic services – counselling, group work &
Family support
• Training, schools & youth work
• Helpline : 0800 0732 606
• BSWA specialises in Violence against Women
issues – saw gap around work on FGM
• Funding from Specialist FGM fund & BCC
• Community education and development approach
as most successful in addressing such a sensitive
• Appointed Somali worker – critical success factor
• Work in multi-agency BAFGM partnership to
ensure a co-ordinated approach
9 community events – attended by 370 people
Developed 4 women’s groups in different areas
2 courses delivered
Youth group developed – organised event for over 60
• Training sessions to professionals
• Supported African Well Women’s Clinic – supported
over 80 women on 1-1 basis from Sudan, Yemen, Ivory
Coast and Gambia
• Successfully conducted PEER research study
FGM in the UK
• backdrop to BSWA research - recent UK research on
Estimating prevalence is notoriously difficult due to secrecy
around FGM
In 2001, an estimated 66,000 women in the UK had
experienced FGM with another 24,000 under 15 years
deemed ‘at risk’ (Dorkenoo et al 2007)
Shifting attitudes among younger residents away from type
III to ‘milder’ forms of FGM or condemnation of the
practice altogether (Morison et al 2004)
FGM in Birmingham
Birmingham’s migrant communities
Demographic data has demonstrated that Birmingham’s emerging immigrant
communities come from areas where FGM is practiced, including Somalia,
Ethiopia, and Sudan
FGM in Birmingham
Somali-speaking children in primary schools by ward in Birmingham
Women of Somali origin are not the only ones affected by or at risk
of FGM, but they are the most frequent users of specialised FGM
health services in Birmingham.
FGM in Birmingham
FGM-related services in Birmingham
Specialised services are currently provided through the Heart of England
Foundation NHS Trust (HEFT) in Birmingham
Recent data from the HEFT has shown rapidly increasing referrals of
women to access these services, with 536 women being referred during
FGM in Birmingham
Data on women who accessed services for FGM through the clinic
from 2009 give a snapshot of the types of FGM being practiced,
populations where women are carrying the highest burden of
health needs, and the spread of sub-populations accessing FGM
Country of Origin
Type 1
Type 2
< 5
Type 3
PEER Methodology
• Training
• Data collection
• Data analysis
Training and research
In total, 16 women from Somali, Eritrean, Sudanese, and
Sierra Leonean backgrounds were recruited & trained
Fifteen peer researchers conducted a total of 90
interviews over the course of four months, from
September to January 2011
Peer researchers met with two friends on three separate
occasions exploring three broad areas
Limitations to research
Qualitative Themes
Life in Birmingham
• General positive views
• English viewed as very important to independence
• Some areas of difficulty:
• Immigration/asylum seeker status
• Language barriers;“[they] can’t speak to [the]
doctor, police, employment centre and
schools…utility company [to] sort out bills and
• Family structure; “In Somalia, we have close-knit
communities that help each other out.”
Marital life
• Male control
• Financial control
• Domestic violence
• Social isolation
• Immigration status
• Living in the UK is changing marriage
• Women aspire to a partnership of equals
• Decreased family pressure
• More mixed-race/religion/love marriages
Female Circumcision
• What communities say about FGM
• How people in the community feel about FGM
• Continuation of the practice
• Circumcision practices
• Reasoning behind FGM
• Pressure to circumcise
What communities say about FGM
• What constitutes FGM
• ‘Sunna’ – Type I/Type IV circumcision
“little nick” “no big deal” “doesn’t hurt her”
• ‘Pharaoni(c)’ – Type III circumcision
“bad” “not allowed by our religion”
• Culture of silence; “It’s all a bit hush hush”
• The religious debate; “ ‘sunna’ is allowed but not [a]
must and sometimes people argue that prophet Mohamed
(peace be upon him) never said it in the ‘hadith’. “
How people in the community feel about FGM
• Anti-FGM; “they hear a lot of men making a joke of it…
saying that if you are with a circumcised woman, she’s
like a doll – she doesn’t feel anything”
• Pro-FGM “When he found the wife was not cut, he was
surprised and he sent her back to the family … The men
said that he was worried that he could not control his
• Indifferent/unaware
Women; “[Women just] get on with their lives [and don’t
discuss it].”
Older generation; “UK girls are out of control”
Continuation of the practice
• FGM is believed to be on the decrease among
younger settled groups in Birmingham
• Some daughters still being taken ‘home’ for
• Newly arrived groups are more likely to either
have experienced FGM or to support its practice
Circumcision practices (outside of UK)
• Most commonly the grandmother or possibly an
older and ‘known circumciser’ in the community
will perform the procedure
• Most often performed in the family home of the
girl undergoing the procedure
• Age of circumcision ranged quite widely across
groups from two years to 20. Age at circumcision
sometimes linked with intention to ‘forget’ or
Reasoning behind FGM
• Arguments for FGM
• Lack of ability to control oneself
• Guarantees ‘purity’ prior to marriage
• Uncircumcised women are ‘unclean’
• Attracts ‘higher calibre’ husband; sexual benefit
for husband
• Arguments against FGM
• Health implications
• The law
• Religion
• Men desire wives who can enjoy sex
Pressure to circumcise
• The role of tradition; “It is what our mothers did
before us and what everybody is doing in their
community. It is our tradition.”
• Pressure to ‘fit in’; “The people in the community
and children that have already been done will tease
you and pressure your family to circumcise you.”
The Wider
Implications of FGM
Effects of circumcision on women’s lives
Experiences with Birmingham health services
Birmingham’s Well Woman Clinic
Access to help and information
The role of advocacy in FGM
FGM and UK law
Effects of circumcision on women’s lives
Emotional and psychosocial wellbeing
• Feeling like “less of a woman”
• Feeling victimised
Physical wellbeing; “I know one of my friends when the
period comes to her she have [sic] to be on the bed three to
four days, she can’t go to her work every month.”
Sexual wellbeing; “Men say that women just lie there
during sex. Men feel their circumcised partners don’t feel
anything and they don’t like that anymore.”
Experience with Birmingham Health Services
Shame, embarrassment or fear of approaching
Negative perceptions of the NHS; “When I look back I
ask myself why the emergency department and GP did not
take my sister’s suffering seriously. Is it because we are less
humans? What if we were rich or different race, would they
have investigated my sister’s pain quicker?”
Lack of awareness and information for both
women and health staff and need for informed
Birmingham’s Well Woman Clinic
Lack of awareness
Belief that women are only made aware of this
service during pregnancy; “Nowadays help is given to
pregnant ladies but not other women. Pregnant women will
be offered help like reversal.” (Somali woman, 39)
Clinic staff described as “helpful” and respectful
Complexities of being opened
Access to help and information
Overall difficulty finding information and
signposting on to support services for FGM
related issues
Trusted sources of information on FGM included
women from their own communities, GPs,
religious leaders and other healthcare services
Priority areas for improved information and
advice were highlighted by researchers
The role of advocacy in FGM
Difficulty identifying allies in the community
Older generation; advocating on FGM is “young
people’s territory”
• Younger generation feel unaware and/or unskilled
to engage in targeted and effective advocacy efforts
Preferred leaders and approaches
FGM and UK law
• High awareness of law prohibiting FGM in the UK
• Women used the law as a tool for abandoning the
practice with more traditional family and
community members both in Birmingham and in
their countries of origin; “it is easier to say no with
the law as an excuse”.
Take home messages
Voices of women:
Khadija ....
Take home messages
• Unmet demand for services
• Low awareness of FGM support services
• Women not aware that FGM is a widespread
practice across many countries
• Poor perceptions of NHS services
• Culture of silence & changing gender roles
• Difference in needs: UK-based girl children
versus newly arrived girls/women
Take home messages
• Women not aware of FGM as child abuse;
don’t know serious consequences of FGM
and see FGM as same as male circumcision
• Communities are focused on basic issues of
survival such as jobs, advice, training and not
on FGM
• Once aware, most communities want to see
it end
Telephone : 0121 685 8687
Helpline : 0800 0732 606
[email protected]
[email protected]