Hiiraan Online

BY GEMMA MITCHELL

With just one question, nurses can play a key part in uncovering and ending a horrific form of abuse affecting women and girls across the world. This is the message from campaigners who have issued a direct appeal for nurses’ help in their fight against female genital mutilation (FGM).

Hoda Ali, an FGM survivor who later became an NHS sexual health nurse after coming to the UK as a refugee, is among those leading the call to action.

Ms Ali was just seven years old when she was “cut” in her home country of Somalia, which is one of the countries where the practice – defined as the intentional altering or injury of female genital organs for non-medical reasons – is most prevalent.

“For us, FGM was something that I thought every single woman around the world had, because it was something that’s so open,” Ms Ali explained to Nursing Times, based on her experience of growing up in Somalia.

But health complications from FGM became evident once she reached puberty and her period began accumulating in her uterus, because it had “nowhere to come out”.

Between the ages of 11 and 17, Ms Ali was in and out of hospital and received care in three different countries – Somalia, neighbouring Djibouti and then from specialists in Italy.

Due to civil war in Somalia, she was unable to return home and, therefore, became a refugee in Europe. She arrived in the UK in 1997, when she was in her early 20s.

She continued to experience health problems related to FGM, including struggling to conceive, and at age 31, she was told that she would never be able to have a baby.

“When you go through female genital mutilation, it’s something you live with for the rest of your life. And also, for me, FGM denied me to be a teenager… and it denied me to be a mother,” said Ms Ali.

The care and support she had received from health professionals throughout her life, however, inspired her to become a nurse. And it was while working as a sexual health nurse at Ealing Hospital, part of London North West University Healthcare NHS Trust, that Ms Ali’s FGM campaigning began.

A significant move Ms Ali made at Ealing was to change consultation forms, so that female patients were more routinely asked about FGM. She explained how, before this, she had noticed that women with issues related to FGM were being sent to sexual health services instead of more appropriate or specialist services, because they were not being identified as FGM survivors by those referring them.

“I realised there was actually no knowledge for the health professionals to help women like me. But if they asked one question, it would have made life so much easier. Because, instead of sending the woman to the sexual health clinic, they would know if she had FGM… they could just send her to gynaecology,” said Ms Ali, who went on to facilitate education sessions on FGM for health workers across north-west London.

This initial work, in collaboration with midwife and fellow survivor Aissa Edon and others, would eventually lead to the launch of a charity, The Vavengers. It is now running a campaign to further spread the message about the importance of asking women about FGM and to improve care for those affected.

The One Question Campaign asks the NHS to add a question about FGM on all female patient forms, and to offer long-term mental health support and reconstruction surgery to survivors.

The campaign team – including Ms Ali and celebrity ambassador Sabrina Elba – attended the House of Lords last week to present their case to NHS leaders, including England’s chief nursing officer Dame Ruth May.

Ms Ali, who has now moved out of nursing and into FGM education and safeguarding in primary schools, said she would dedicate the rest of her life to the cause of ending FGM and improving support for survivors.

“I will always be speaking for the future generation, because I can’t change what happened to me. I can’t change that I don’t have children. But you know what I can do? I can change tomorrow. And that is what I want for survivors and for our patients,” she said.

“I want every medical professional to have that kind of idea as well to say, ‘we can’t change what happened to this woman, or to these girls, but we can help them to receive the care, the support that they need at the right place at the right time’. Because that’s what we don’t have.”

“It’s not just the cutting... it’s the effects on them, both mentally and physically"

Also supporting the campaign is Huda Mohamed, an FGM specialist midwife at Whittington Health NHS Trust in north London. Her FGM clinic takes patients from across the capital and beyond, and has seen around 800 women between 2018 and 2022.

Ms Mohamed, who is both a registered nurse and midwife, said it was “very common” for women to ask about reconstructive surgery. However, she had to tell them that the service was not provided in the UK and they would need to travel to elsewhere in Europe, which many could not afford.

She called for reconstructive surgery to be part of a “holistic” package of care that should be offered to women who have had FGM, as well as mental health support.

“It’s not just the cutting that they had when they were children or were babies, it’s the effects on them, both mentally and physically,” she said.

“When they were young, they were cut, so they’ve been traumatised. Now, in adulthood, most of them have problems with periods, fertility, infections; ‘not feeling whole’, as the women who come to my clinic, for example, tell me.

“Some women will feel uncomfortable when they are having sex every time. They have flashbacks every time they wake up. So, you need proper mental health support, emotional support. They need appropriate clinics that understand their needs.”

FGM is illegal in the UK and it has been mandatory since 2015 for health professionals to record and report known cases.

At present, women only tend to be asked about FGM when there are suspicions, but the campaign wants it to become universal and routine, which will improve data and remove risks of discrimination. As Ms Mohamed stressed, “FGM is global and is not only one race.”

A 2020 report by the End FGM European Network found that FGM was present in more than 90 countries around the world, with at least 137,000 survivors living in the UK. “So, it’s so important to ask everybody, that’s what we are doing in maternity,” said Ms Mohamed. “We ask everyone regardless of colour, your race, your background, have you had FGM?”

From left, Huda Mohamed, Sabrina Elba and Leyla Hussein. Credit: PA Images / Alamy Stock Photo

Another high-profile backer of the campaign is psychotherapist Dr Leyla Hussein, an FGM survivor and activist, who set up the first counselling service for FGM survivors in Europe and, in 2013, hosted a groundbreaking Channel 4 documentary called The Cruel Cut.

Speaking to Nursing Times, Dr Hussein said it was a specialist nurse in London who asked her about FGM and that if that had never happened, then her daughter may have been subjected to it too.

“If she never intervened, if she never asked me that question, I cannot tell you whether my daughter would have been cut or not. I cannot. I don’t know,” she said.

“Even thinking about it really scares the hell out of me. How many mums or women are put in that situation? So that question is key,” added Dr Hussein.

Asked what changes nurses could make today, Dr Hussein said she wanted them to “really push for mandatory training for all health professionals” on FGM and that she thought it should be taught as standard in nursing schools.

“By having that basic information, you could be saving a woman’s life, literally,” she said.

At the Lords event, The Vavengers team presented Dame Ruth with a report on the need for change, which highlighted that more than half of the survivors the charity works with had not been asked about FGM by health professionals.

Dame Ruth agreed to take the report back to her office and also requested to shadow Ms Mohamed in her FGM clinic.

Additionally, Baroness Rosie Boycott agreed to chair a new “change board” alongside The Vavengers chief executive Sema Gornall.

Speaking to Nursing Times, Ms Gornall said that, by asking women the question about FGM and knowing the services to refer them to, nurses could “changes lives on so many levels”.

The campaign was also about addressing the current “data poverty” in the UK on FGM, she said, with current figures widely acknowledged to be a major underestimate.

Meanwhile, Ms Ali told Nursing Times she wanted to share a message with nurses that she closes her education workshops with. “Cultural acceptance does not mean accepting the unacceptable. Female genital mutilation is unacceptable, and it has no place in our world,” she said.