Tackling female genital mutilation through practical partnerships

Female genital mutilation (or FGM) is a serious global issue that causes long-term health problems for a number of women in our local community. In this blog post, Juliet Albert, specialist FGM midwife at Imperial College Healthcare NHS Trust, discusses her long career providing care to local women who have experienced FGM.

What is FGM?

FGM is a cultural practice in which the female genitals are deliberately cut, injured or changed with no medical reason for doing so. It is extremely painful and can lead to women suffering serious long-term health issues, including constant pain, repeated infections that can cause infertility, and mental health issues. FGM can cause potentially life-threatening problems during labour and childbirth.

It is more widespread than people may think: it is practised globally and we have women accessing our services in north west London who come from Somalian, Eritrean, Indonesian, Sudanese, Malaysian and Egyptian communities as well as many others. It is a complicated issue, because a lot of the families affected are doing it because they feel they have to; they don’t want their daughters to be unmarriageable or excluded from the community.

Our FGM clinics

We set up our first FGM clinic in the community in 2007 to give specialist care to women with FGM. It was the first midwife-led, community-based FGM clinic in the UK and unique in providing accessible, local care to women affected by the practice, whether pregnant or not. We recently brought this clinic into our central FGM service at the Trust, through which we now also run two hospital-based FGM clinics where we support pregnant women who need dedicated maternity care. All our FGM clinics are now based at Queen Charlotte’s & Chelsea and St Mary’s hospitals.

Some women who have experienced FGM and need support don’t want to speak to their GP about it, so women can refer themselves to our confidential FGM service without telling their family or their GP. It’s a fast-track service, where we see them within two weeks. 

I first became aware of FGM affecting women in our community in 1997 when I was looking after a Somali woman who was giving birth to her second baby. When I examined her during her labour, I realised immediately she’d had FGM. It then occurred to me that there was a very large Somali population in our local area, particularly in the London boroughs of Ealing, Brent and Hammersmith and Fulham, and as it’s often a cultural practice, there could be more women with FGM who needed our help. So I went to a study day by FORWARD, the leading charity on FGM, to learn more about it. I then set up a working party with a number of doctors and other midwives to review the way we were providing care for women with FGM at Queen Charlotte’s, and from there we launched the FGM clinics.

Supporting women locally

We see between 60 and 100 women with FGM per month in our three clinics, including women who have booked to have their baby at St Mary’s or Queen Charlotte’s. We also see younger women who want to know what type of FGM they’ve got or who want to be deinfibulated (a minor ‘opening’ procedure, sometimes known as ‘reversal’, for women with the most severe type of FGM). We see a cohort of older women who have had children but who suffer chronic pain or problems with recurrent infections.

At the three clinics, our specialist FGM midwives can determine the type of FGM a woman has. If it is the most severe type, the midwives can carry out the deinfibulation procedure under local anaesthetic in our clinics, which can alleviate pain. 

For patients who need more than just treatment for the physical effects of FGM, we have specialist FGM health advocates at the clinics who speak Somali and Arabic – languages which are widely spoken by women affected by FGM in north west London. They provide extra support for patients both on the phone and at appointments. We also have a counsellor in the clinics so that we can help women to deal with the psychological impact of FGM.

We work with other local organisations to provide care to as many women as we can in our community. One example is Midaye, a Somali grassroots organisation that supports women in  west London and trains specialist FGM health advocates.

The future of care for women affected by FGM

In the last few years in the UK, we’ve come to really acknowledge the damage that FGM causes and, as such, the law has changed – it is now recognised as a form of child abuse, we have clear safeguarding policies in place and we report the extent of FGM to the Department of Health.

We continue to see a lot of demand for our FGM services, so our aim is to keep providing essential support to women in north west London. Funding from Imperial Health Charity has meant we can continue to improve our FGM service and reach out to more women in the local area. We’re also helping other trusts to set up their own midwife-led clinics based on our model, so that more women can access vital care: Chelsea and Westminster Hospital NHS Foundation Trust came to observe our clinics before they set up their FGM service, and we have trained some GPs in Bristol to carry out deinfibulation.

My hope is that one day there will no longer need to be any clinics, because nobody will have to go through the agony of FGM anymore. 

Learn more about FGM services at Imperial College Healthcare NHS Trust.