2Measuring the problem
City University Study
13.Precise data on the prevalence of FGM in the UK remains elusive despite improvements to the quality of research that has been undertaken in recent years. In 2015 the Home Office attempted to enhance its understanding of the scale of FGM in England and Wales by part-funding a study by City University. The study examined data on the incidence of FGM in countries in which it traditionally occurs and then projected incidence rates onto the relevant immigrant communities in England and Wales, the size of which were derived from the 2011 Census. The study estimated that there were approximately 137,000 women and girls subjected to FGM who were permanently resident in England and Wales in 2011.16
14.The study also found that almost every local authority area was likely to contain women living with the effects of FGM and provided an indication of where cases of FGM were likely to be concentrated—London had by far the highest prevalence at an estimated 28.2 per 1,000 women aged 15–49.17
15.Although it represented a credible starting point for measuring FGM prevalence, the study itself acknowledged some of the limitations, including that it did not take account of migration that had taken place since 2011 and that it was problematic to assume that the prevalence of FGM in practising countries was necessarily mirrored in the diaspora from those countries. It also identified that in some countries there were strong regional or social variances in FGM practices which would mean that women who emigrate might not be representative of a country as a whole. Moreover, attitudes within a diaspora are not fixed; grassroots groups have had a great deal of success in encouraging families to abandon FGM at community level and it was not possible to take account of this kind of attitudinal change in the method used by the study.18
16.The study suggested that approximately 60,000 girls aged 0–14 years were born to women who had undergone FGM. Karen Bradley, then Minister for Preventing Abuse, Exploitation and Crime, told us that this figure represented the “sorts of numbers we are talking about who are at potential risk.”19 However, the City University Report itself was more cautious of making such a claim:
Our earlier report attempted to assess the numbers of girls born in England and Wales who could be described as being ‘at risk’. This is no longer appropriate. On the one hand, qualitative research has shown that attitudes to FGM have changed on migration and in response to community based programmes and many families have abandoned it while on the other, there are still reports of girls living in England and Wales being subjected to FGM or threatened with it. In neither case, has the extent been quantified in a way which can be used in numerical estimates at a population level.20
17.Some progress has been made in the collection of data on FGM. However, the Government must adopt a more sophisticated, data-driven approach to eradicating it. It is a hidden crime and the first step towards tackling it effectively is to measure it properly. Only then can resources be allocated accordingly. In the UK, despite the publicity surrounding the Government’s Summit on FGM in 2015, there is still a paucity of information on the scale of FGM, on its trends over time and on the number of girls at risk. There have been a small number of statistical analyses and data-gathering exercises but they have been conducted in isolation and without reference to a national strategy. As a result the statistics lack the necessary degree of utility to safeguarding and law enforcement agencies.
18.We recommend that the Home Office identify a more reliable methodology for measuring the number of girls at risk of undergoing FGM in the UK. This approach would be best served by engaging directly with women and families affected by FGM, for example through the use of anonymised surveys of a statistically meaningful number of women in families from practising countries. Research should also seek to ascertain attitudes towards FGM, including motivations for continuing to use the procedure, and awareness of the law prohibiting it. It should also be used as an opportunity to learn exactly where in practising countries women had their FGM carried out. Such information would enrich the international intelligence picture, including for UK Border Force staff in their work to prevent girls from being taken abroad to undergo FGM.
Mandatory recording
19.In a further effort to gather more information on FGM in the UK, data has been collected across the NHS since April 2015 as part of the Department of Health’s prevention programme.21 It became mandatory for all NHS acute healthcare Trusts to report and submit information to the FGM Enhanced Dataset from 1 July 2015 and for all mental health trusts and GP practices to do this from 1 October 2015.22 Clinicians across all NHS healthcare settings are required to record when a patient with FGM is identified as part of clinical examination during routine care provision.23 The data collected are sent to the Health and Social Care Information Centre (HSCIC), where the information is anonymised, analysed and published in aggregate form. The full dataset contains 30 data requirements including patient demographic data, specific FGM information and referral and treatment information. Controversially, healthcare professionals are required to submit patient identifiable data which is then centralised. The Department of Health has stated that personal information is collected only for internal quality assurance and to avoid duplicate counting.24 Although patient consent does not need to be sought, transparency is required.25
20.The HSCIC published the first annual collection of mandatory recording results in July 2016.26 The table below shows the local authority areas with the highest prevalence of FGM.
Table 1: Local authority areas with highest FGM prevalence, England, April 2015 to March 2016
|
Local authority |
Newly recorded |
Local authority |
Total attendances |
|
Birmingham |
435 |
Brent |
1250 |
|
Bristol |
385 |
Bristol |
705 |
|
Brent |
325 |
Birmingham |
520 |
|
Manchester |
310 |
Harrow |
460 |
|
Southwark |
290 |
Ealing |
355 |
|
Enfield |
215 |
Manchester |
350 |
|
Ealing |
175 |
Southwark |
320 |
|
Lambeth |
175 |
Enfield |
265 |
|
Sheffield |
165 |
Lambeth |
200 |
|
Camden |
140 |
Sheffield |
185 |
|
Greenwich |
130 |
Camden |
175 |
|
Leeds |
125 |
Hillingdon |
175 |
Source: HSCIC, Female Genital Mutilation (FGM) Enhanced Dataset: April 2015 to March 2016, experimental statistics
Notes: Newly Recorded women and girls with FGM are those who have had their FGM information collected in the FGM Enhanced Dataset for the first time. This will include those identified as having FGM and those having treatment for their FGM. ‘Newly recorded’ does not necessarily mean that the attendance is the woman or girl’s first attendance for FGM.
Total Attendances refers to all attendances in the reporting period where FGM was identified or a procedure for FGM was undertaken. Women and girls may have one or more attendances in the reporting period. This category includes both newly recorded and previously identified women and girls.
The results identified:
- 5,702 newly recorded cases of FGM and 8,656 total attendances where FGM was identified or a procedure for FGM was undertaken;
- 43 newly recorded cases of FGM involving women and girls born in the UK. Of those with a known FGM type, more than 40% were reported with FGM Type 4—Piercing;
- 18 newly recorded cases of FGM reported to have been undertaken in the UK, including 11 women and girls who were born in the UK. Where the nature of the procedure was known, around 10 were reported with FGM Type 4—Piercing;
- 52% of newly recorded cases and 58% of total attendances related to women and girls from the London NHS Commissioning Region;
- 90% of women and girls with a known country of birth were born in an Eastern, Northern or Western African country; 6% were born in Asia; and
- Types 1 and 2 FGM had the highest rate of incidence, 35% and 31% respectively, where the FGM Type was known.27
21.In July 2015, the then Minister said that the data published by HSCIC “will provide more information on where and when FGM took place so we can get a better understanding of the scale of the crime taking place within the UK.”28 HSCIC’s annual figures show that 177 NHS trusts (73.4%) and 664 GP practices (8.7%) are registered on the FGM Enhanced Dataset collection system. Of those, just 150 organisations submitted one or more attendance records during the reporting period—112 NHS trusts and 38 GP practices.29 In London, where the majority of FGM cases are believed to be located, just six out of approximately 1,500 GP practices recorded cases.30
Table 2: Number of NHS organisations recording FGM cases, England, April 2015 to March 2016
|
London |
Midlands and East England |
North of England |
South of England |
Total |
|
|
NHS Trusts |
23 |
32 |
34 |
23 |
112 |
|
- Providing mental health services |
6 |
4 |
4 |
1 |
15 |
|
- Not providing mental health services |
17 |
28 |
30 |
22 |
97 |
|
GP practice |
6 |
11 |
16 |
5 |
38 |
|
Total |
29 |
43 |
50 |
28 |
150 |
Source: HSCIC, Female Genital Mutilation (FGM) Enhanced Dataset: April 2015 to March 2016, experimental statistics
Much of the data submitted is incomplete. For instance, the FGM type was recorded for only 44% of women; the country of birth was recorded for only 38%; and the age when FGM took place was recorded for only 24%. Data relating to other metrics was similarly incomplete.
22.Alison Macfarlane, Professor of Perinatal Health, City University, was reported as saying that the incompleteness of the data “calls into question the usefulness of the statistics for planning services” and recommended using anonymised, sample surveys in future.31 She noted that many clinicians were uncomfortable with the requirement to record data on women affected by FGM without asking for their consent, “even though it would be feasible to ask them”.32
23.A letter from clinicians published by the British Medical Journal in September 2015 summarised the concerns. The authors said the commitment not to release patient identifiable data to third parties (such as the police and the Crown Prosecution Service) was “inadequate and not future-proofed”. Furthermore, there was dissatisfaction that frontline clinicians were responsible for explaining to patients that data would be collected. The letter said, “The initiative has no evidence of benefit, wastes precious clinical time, and will profoundly damage trust in health professionals who will either collude or ignore the imperative.”33
24.Since 2015, there has been a requirement on clinicians to record and report FGM cases which they identify as part of clinical examinations. While we agree that they are best placed to help to measure this appalling crime, we are not convinced that the present standard of recording meets the Home Office’s expectation that it will lead to a “better understanding of the scale of the crime taking place”. The most conspicuous weakness in the data is its incompleteness which makes it difficult to use to set benchmarks against which trends can be measured. We are alarmed by reports that some clinicians are ignoring the requirement to record data on the basis that they do not recognise its purpose. We expect NHS employers and the Royal Colleges to take a hard line against such attitudes and call for the Department of Health to write to frontline clinicians to remind them of the duty, and the purpose of mandatory recording, and to reissue guidance. In areas where recording is far below expectations, training on the harm resulting from FGM, the importance of fulfilling the duty to record FGM incidence and dealing with affected women should be commissioned.
16 City University, Prevalence of Female Genital Mutilation in England and Wales: National and local estimates, July 2015, p5
17 City University, Prevalence of Female Genital Mutilation in England and Wales: National and local estimates, July 2015, p18
18 City University, Prevalence of Female Genital Mutilation in England and Wales: National and local estimates, July 2015, page 14
19 Oral evidence taken on Female Genital Mutilation, 12 July 2016, Q29. Karen Bradley MP was replaced by Sarah Newton MP as the Minister responsible for FGM policy on 17 July 2016
20 City University, Prevalence of Female Genital Mutilation in England and Wales: National and local estimates, July 2015, page 26
21 Mandatory recording should not be confused with mandatory reporting which is the requirement to report FGM cases in under 18s to the police and is assessed below.
23 HSCIC, Female Genital Mutilation (FGM) Enhanced Dataset: April 2015 to March 2016, experimental statistics, 21 July 2015, page 6
24 Department of Health, FGM prevention programme, September 2015, page 3
25 To meet the requirement to provide a ‘fair processing’ notification to patients, clinicians are required to give the patient the FGM leaflet “More information about FGM” (2015)
26 HSCIC previously published data on a quarterly basis
27 HSCIC, Female Genital Mutilation (FGM) Enhanced Dataset: April 2015 to March 2016, experimental statistics, 21 July 2015, page 4
28 Home Office, Government response to the Home Affairs Committee Report, Female Genital Mutilation: follow-up, 22 July 2015
29 There were 241 NHS trusts and about 7,600 GP practices active at the start of the reporting period (1 April 2015)
30 HSCIC reported that more women and girls newly recorded with FGM lived in the London NHS Commissioning Region (51.5%) than in any other commissioning region.
31 Guardian, Caution needed with FGM statistics, 27 July 2016. Alison Macfarlane conducted the City University study on FGM prevalence in England and Wales
32 Guardian, Caution needed with FGM statistics, 27 July 2016
© Parliamentary copyright 2015
13 September 2016