The mists begin to clear on FGM statistics

Readers may recall that I have long been interested in trying to unpick the data on female genital mutilation in the UK. The general standard of debate on this topic is woefully uninformed by actual facts. News pieces and campaign materials have traditionally waved around (almost) meaningless statistics about the numbers of girls being at risk of FGM, without explaining what they mean by “at risk” or how severe that risk might be.

The numbers tend to be horrifying and this has at least two extremely serious consequences. The first is that the practice of FGM among migrant communities in the UK is used as a damning indictment of their failure to integrate, to accede to British law and custom, or more broadly as evidence the uncivilised, backwards ways of immigrants and especially Muslims.

Secondly, for many years there has been a clamorous call to demand explanations why nobody in the UK has been successfully prosecuted for conducting FGM. It has long been assumed (and not just among the spittle-flecked rabble of the Daily Mail comments section) that some sort of political correctness must be the reason why police, prosecutors, social services and child services have all been deliberately averting their gaze from the brutes who continue to cut up the genitals of little girls. But as I have written before, there is another possible explanation as to why these offences are never prosecuted – could it be because in fact these crimes very rarely happen in the UK?

This week the Health & Social Care Information Centre published their latest quarterly bulletin on FGM. This exercise (still described as ‘experimental’) collates reports from Health Trusts around the country which count the numbers of new cases that have come to light within the NHS. The vast majority of cases are adult women (mostly aged 18-39) and typically come to light during obstetrics & gynaecology care in pregnancy and childbirth.

As the headlines explained, this latest quarter found around 1200 new cases of FGM. For the first time, however, the data included some numbers for where the women and girls were born and where the FGM procedure had occurred.

Before I go any further let me stress that the statistics here are patchy and incomplete. We are only considering newly discovered cases, not the total, and there are huge holes in the data sets where the relevant information could not be or was not recorded. Nonetheless the numbers are revealing.

Of the 1242 cases, there were 532 where the country of birth was recorded. Of those, precisely 11 cases were of girls or women born in the UK. That means that 98% of cases of FGM in the UK (from this data set and where the info was logged) were on women born outside of the UK.

Even more usefully, there were 319 cases in which the data recorded where in the world the FGM was undertaken. Of those, seven were reportedly undertaken in the UK. Again, 98% of FGM procedures happened outside the UK.

These numbers 11 cases and 7 cases respectively) are so tiny we should be aware of the risks of data errors and statistical noise. For instance, genital piercings can be classified as Type 4 FGM (in some cases this is legitimate and accurate – piercings are sometimes inflicted upon girls as a form of FGM) but it does create obvious scope for confusion and miscategorisation.

There is one incredibly important question which the HSIC still fails to address or answer: How many of the 1242 new cases of FGM are women who were already resident in the UK before they were mutilated? If we had an answer to that question, everything would suddenly become a lot more meaningful. In the meantime, what is this data telling us? It looks to me like what we are seeing is that relatively large numbers of women who move to the UK from FGM-practising countries such as Nigeria, Kenya and Somalia have already been cut when they move here. This should be a clear and uncontroversial point. There is an obvious and serious need for health professionals to be aware of this and to have the expertise necessary to provide these women with the care and medical treatments they might require to heal the damage.

The other key takeaway from the data is that amongst girls who have been born in Britain, even to communities where it has been traditionally practised, FGM is exceptionally rare. For years we have been told that anything up to 120,000 girls in the UK are “at risk” of FGM, an estimate based on numbers of girls born in the UK to families from the relevant parts of the world. If the true numbers were anything even vaguely on this scale we would expect to see far, far more new cases coming to the attention of the authorities.

To be clear, we cannot be sure from this data that there aren’t lots of girls who are born elsewhere, brought intact to the UK as children, taken out of the country to be cut elsewhere and then brought back again, but this really seems something of a stretch to me. A more credible interpretation of the data would be that FGM remains a huge medical and human rights catastrophe in many parts of the world, but that when people move to the UK, with very few exceptions, they abandon the custom.

We still don’t have the statistics to speak about any of this with authority. As the academic cliché would have it, more research is necessary. If I had one wish on this front, however, it would be that when journalists, campaigners and politicians talk about the thousands of women in Britain who have suffered FGM they explain to people that the vast majority were living elsewhere when it happened. That little nugget of nugget of knowledge entirely transforms the debate and would do so in a much more constructive direction.

Biopower: Joining the dots from sexual violence to genital mutilation

My current dead-tree companion is Amalendu Misra’s new book The Landscape of Silence: Sexual Violence Against Men in War. it is a fine, scholarly work that documents the gruesome extent of sexual violation of men and boys through history, but mostly in current and recent conflicts, from the Congo and the Balkans to Latin America and Abu Ghraib. More importantly Misra, a senior policics lecturer at the University of Lancaster, attempts to contextualise, theorise and (as is the current academic fashion) ‘problematise’ the phenomenon.

A key question in this area is why warring parties so often resort to sexualised torture, abuse and mutilation when objectively speaking, it would be much more quick and simple to put a bullet in the head of their victim? One central answer to that question, Misra suggests, is Foucault’s concept of biopower. [Read more…]

FGM prosecutions and the question nobody dares to ask

The acquittal of Dr Dhanuson Dharmasena yesterday means that more than 20 years after specific legislation was passed, there remains not one single British conviction for inflicting female genital mutilation (FGM).

The case against the obstetrician was always a strange one. His patient was a survivor of previous Type 3 (ie the most severe) form of FGM, and after saving her life with an emergency operation during labour, he stitched her up in such a way that appeared to restore her post-FGM state of mutilation, rather than reverse it. Dr Dharmasena always insisted that the suture was no more than necessary to stop her bleeding. The jury took less than 30 minutes to rule him (and his co-defendant) not guilty. All medically-trained observers who have followed the trial now seem to agree that the verdict was correct and the charges should never have been brought.

So why were the charges brought and pursued so vigorously? I can only presume it is a consequence of the enormous pressure being felt by the CPS and other agencies, including the police, to begin securing convictions for FGM offences. If anyone still believed that the powers-that-be are scared or shy of prosecuting FGM cases for fear of appearing culturally insensitive or racist or whatever else, the ill-judged prosecution of Dr Dharmasena should set them straight. [Read more…]

Asking some awkward questions about FGM

Female genital mutilation is always an abhorrent obscenity. In its more invasive forms it carries significant implications for health and, most obviously sexual health. I have no quibble with the Home Affairs Select Committee that the failure to protect girls in the UK from the practice is a national scandal. We have victim testimony and medical case studies to confirm that girls born and raised in the UK, who should have been under the protection of our welfare and justice systems, have been subjected to this gruesome form of violence.

That said, I have longstanding and lingering doubts about some of the evidence that is always produced when we discuss the nature and extent of FGM in the UK. I stress at this point that from hereon in, this blogpost will be asking questions, not providing answers. However the questions I ask are, I believe, much bigger and more important than anyone is currently crediting. I raise them here not to be a contrarian bellend with an eye on a column in Spiked, but because it concerns me that the FGM prevention agenda could have serious unintended consequences that I will return to at the end.

Media coverage of the new MPs report typically repeat the claim that up to 170,000 women in the UK may have been subjected to FGM and 65,000 girls are currently at risk. The former statistic comes from a piece of research by Julie Bindel earlier this year, the latter is a longstanding estimate originating in research done for the charity FORWARD by Efua Dorkenoo in 2006.

And yet despite anecdote and assumption, actual documented incidents of girls from this country being ritually mutilated, either in this country or being taken abroad for the procedure, is scant. The Association of Chief Police Officers told the Select Committee that in the last five years the police had dealt with over 200 FGM-related cases nationally of which 11 had been referred on to the Crown Prosecution Service for consideration. Of the 69 referrals made to the Metropolitan Police Service in 2013, only 10 were recorded as an FGM offence, the others included unfounded concerns and cases where the cutting had happened before the victim had moved to the UK. Health professionals also report seeing many mutilated women but, again, in almost all cases the mutilation appears to have predated UK residence.

Is it credible that a problem on the scale reported could throw up so few confirmed cases? Earlier this year a Channel 4 News Factcheck blog explained very clearly how the prevalence statistics were calculated.

“Estimates of prevalence like this are more like educated guesswork than hard science. There are ranges of uncertainty built into every stage of the process.”

To be fair, the Dorkenoo report is very frank about some of the research’s own limitations. This is reflected, to an extent, in the MPs’ report, but the way they acknowledge this is typical:

“Yet, apart from a small number of high-level statistical analyses and anecdotal evidence, we have very little information on the children who are most at risk, and even the extent to which the cutting is occurring in this country or by taking girls abroad. Meanwhile, as many as 170,000 women in the UK may already be living with the life-long consequences of FGM. We welcome efforts by the Government and others to draw a more accurate picture. However, even in the absence of precise data, it is clear that the extent of the problem is very significant”

In the absence of precise data, is it really clear? I’m not so sure. (Of course, in one sense any extent of FGM, even one case, is significant, but I don’t think that’s really what they mean.)

To understand the doubts about the prevalence data we are given, consider first the phrase “65,000 girls are at risk of FGM.” What does that mean? Simplistically , it means they were born into communities where FGM is practiced, but what risk does that carry? Is their risk of being mutilated 1% or 99%? When we are talking about prevalence and incidence, ‘at risk’ is an almost useless phrase. A quick read of the research reveals that the phrase ‘at risk’ is applied to any girl born to a woman born in any country were FGM is practised, including those where the practice is close to universal and those where it is a comparative rarity. Averaging out such risks would be meaningless, so it is impossible to say what magnitude of risk we are talking about here.

Look at the Dorkenoo paper closely, and other issues arise. The research uses census data for women who were born in countries where FGM is practised and is quite explicit that the research did not control for ethnic or cultural variations within that country. The single largest group within their data are Kenyans, who provide almost a third of their estimated total for women who have been mutilated. However, the British-Kenyan community is by no means typical of the population in Kenya. A large proportion are Kenyan-Asians, mostly of Hindu-Indian culture, who were expelled after the Kenyan Immigration Act of 1967. Rates of FGM among that community are (I would presume) pretty much zero. Other people who will have told the census they were born in Kenya include many white stragglers from the colonial era (Richard Dawkins, Cristina Odone and Peter Hain MP were all born in Kenya). Even among ethnic Kenyans in the UK, large numbers are educated middle-class professionals, especially doctors and nurses, and it is reasonable to presume that (while of course not exempt from risk) they are significantly less likely to be practising FGM than representative samples of the generally poor and uneducated Kenyan population, from which the risks to British-Kenyan girls are extrapolated.

One other serious question mark hanging over this research relates to how migrant communities behave. As acknowledged in the select committee’s report, there is evidence that the behaviour of (at least some) immigrant communities to the UK begins to change soon after they arrive in this country. It is by no means self-evident that a family of North African origin are going to stubbornly retain all the cultural habits of their former home when they begin a new life elsewhere.

And this is where the first of my wider concerns comes in. Anyone who regularly reads comments on social media or blogs knows the extent that FGM can be instrumentalised in entirely different debates. Despite a minimal theological connection to Islam, and widespread practice among Christian and other religious communities in parts of Africa, it is regularly used as evidence of the barbarity of Muslims. Those who would impose a fascistic monoculture upon this country use widespread FGM as evidence of the failure of supposed multiculturalism and the evils of cultural relativism and political correctness. A narrative holding that large numbers of savage dark-skinned foreigners are whisking their daughters out of the country to have their vaginas sewn up or their clitoris excised grips with troubling persistence in the public imagination.

There is a lot about the FGM debate which reminds me of the inflated concerns about sex trafficking about a decade ago. Who can forget Denis Macshane standing up in the House of Commons, waving a copy of the Daily Mirror and insisting that there were 25,000 sex slaves on the streets of Britain? The campaigning and false statistics drove two massive nationwide police operations which ultimately resulted in the rescue of a very small number of genuine victims of trafficking, rape and false imprisonment. Yes, such victims did and do exist. However the main victims of Pentameter I and II were entirely consenting, freely operating foreign-national sex workers who were rounded up by the hundred, torn away from their lives and summarily deported

Just as there really are victims of appalling sex trafficking, there are also victims of female genital mutilation. I do not doubt that there will be girls in this country who are either subjected to the cruel practice here in the UK or perhaps over the summer holidays they will be taken out of the country, with or without knowledge of their impending fate. Just one case is one too many, but whether such cases number in the dozens, the hundreds or the thousands must make a huge difference as to the policies we instigate to address the problem. If the problem were much more rare than we are led to believe, then it could cause considerable harm to place communities from Somalia, Sudan, Egypt and other FGM-practising countries under intrusive practices of surveillance and suspicion, while having little or no effect on the problem. If there are indeed thousands of cases each year, then it might be entirely justified to initiate more wide-ranging policies.

What concerns me most about the lack of strong research into the prevalence of FGM is not just that we do not know the extent of the problem. It is that it seems everyone involved knows we are clueless about the extent of the problem and they seem to have little genuine desire to find out the truth.