Understanding FGM in Birmingham

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Understanding FGM in Birmingham

• Nasheima Sheikh
• Khadija Jaamac

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BSWA WHAT WE DO

• Provide four refuges in Birmingham Solihull
• Provide Outreach support in the community work
  with high risk women
• Support women going through Courts and with
  injunctions
• Therapeutic services counselling, group work
  Family support
• Training, schools youth work
• Helpline 0800 0732 606

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BSWA FGM WORK

• 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
  issue
• Appointed Somali worker critical success factor
• Work in multi-agency BAFGM partnership to ensure
  a co-ordinated approach

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BSWA FGM WORK

• 9 community events attended by 370 people
• Developed 4 womens groups in different areas
• 2 courses delivered
• Youth group developed organised event for over
  60 youth
• Training sessions to professionals
• Supported African Well Womens Clinic supported
  over 80 women on 1-1 basis from Sudan, Yemen,
  Ivory Coast and Gambia
• Successfully conducted PEER research study

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FGM in the UK

• backdrop to BSWA research - recent UK research
  on
• FGM
• 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)

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FGM in Birmingham
Birminghams migrant communities Demographic
data has demonstrated that Birminghams emerging
immigrant communities come from areas where FGM
is practiced, including Somalia, Ethiopia, and
Sudan
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FGM in Birmingham
Somali-speaking children in primary schools by
ward in Birmingham (2008)
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.
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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 2008-2009.
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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 services.
Country of Origin Type 1 Type 2 Type 3 Total
Eritrea 3   15 18
Ethiopia lt 5     lt 5
Gambia 13     13
Kenya lt 5     lt 5
Iraq lt 5     lt 5
Somalia 20 6 50 76
Sudan     9 9
Yemen lt 5 6   gt 6
Unknown       133
Total  44  12  74 263
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• PEER Methodology
• PEER
• Training
• Data collection
• Data analysis

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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

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Qualitative Themes
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Life in Birmingham

• General positive views
• English viewed as very important to independence
• Some areas of difficulty
• Immigration/asylum seeker status
• Language barriersthey cant speak to the
  doctor, police, employment centre and
  schoolsutility company to sort out bills and
  housing
• Family structure In Somalia, we have close-knit
  communities that help each other out.

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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

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• Understanding
• 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

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What communities say about FGM

• What constitutes FGM
• Sunna Type I/Type IV circumcision
  little nick no big deal doesnt hurt her
• Pharaoni(c) Type III circumcision
  bad not allowed by our religion
• Culture of silence Its 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.

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How people in the community feel about FGM

• Men
• Anti-FGM they hear a lot of men making a joke
  of it saying that if you are with a circumcised
  woman, shes like a doll she doesnt 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 wife.
• Indifferent/unaware
• Women Women just get on with their lives and
  dont discuss it.
• Older generation UK girls are out of control

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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
  circumcision
• Newly arrived groups are more likely to either
  have experienced FGM or to support its practice

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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
  remember

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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

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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.

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• The Wider
• Implications of FGM
• Effects of circumcision on womens lives
• Experiences with Birmingham health services
• Birminghams Well Woman Clinic
• Access to help and information
• The role of advocacy  in FGM
• FGM and UK law

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Effects of circumcision on womens 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 cant go to
  her work every month.
• Sexual wellbeing Men say that women just lie
  there during sex. Men feel their circumcised
  partners dont feel anything and they dont like
  that anymore.

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Experience with Birmingham Health Services

• Shame, embarrassment or fear of approaching
  services
• Negative perceptions of the NHS When I look
  back I ask myself why the emergency department
  and GP did not take my sisters suffering
  seriously. Is it because we are less humans? What
  if we were rich or different race, would they
  have investigated my sisters pain quicker?
• Lack of awareness and information for both women
  and health staff and need for informed
  questioning

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Birminghams 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

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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

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The role of advocacy in FGM

• Difficulty identifying allies in the community
• Older generation advocating on FGM is young
  peoples territory
• Younger generation feel unaware and/or unskilled
  to engage in targeted and effective advocacy
  efforts
• Preferred leaders and approaches

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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.

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Take home messages
Voices of women Khadija ....
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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

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Take home messages

• Women not aware of FGM as child abuse dont 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

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BSWA CONTACT DETAILS

• Telephone [phone]
• Helpline 0800 0732 606
• Nasheima.sheikh_at_bswaid.org
• Khadija.jaamac_at_bswaid.org