First off, if you’ve not really heard about FGM (female genital mutilation) before, prepare to be enlightened. Often hailed as a silent killer, I had the opportunity to talk to founders Mabel & Hoda of the London-based charity, The Vavengers, about what FGM is, stigma’s associated with FGM and religion, how real the issue of FGM is in the UK, and most importantly how we can educate our medical practitioners and people experiencing FGM PTSD. If you read anything today, please let it be this.

For those reading who want to know a bit more about FGM, how would you define and categorise all types of FGM?

Female Genital Mutilation/Cutting is the total or partial removal of the female genitalia for non-medical purposes, resulting in long term physical and psychological trauma for the survivor. FGM/C is often a precursor to other forms of gender-based violence such as child marriage and obstetric fistula.

Side effects include scar tissues, ongoing UTIs, increased risk of HIV/AIDS and complications in pregnancy and childbirth including obstructed labour.

FGM is often associated with religion, is this always the case? And if not, what are the reasons FGM still happens today?

Although FGM is practised by some Muslims and Christians in some parts of the world, it is not required by Islam, Christianity or Judaism and is not supported in the Bible or Koran.

FGM continues to happen for a multitude of reasons.

How prevalent is FGM in the UK?

There are roughly 137,000 survivors living in England & Wales and a further 60,000 girls who’ve been born to mums with FGM, and so are potentially at risk. It has been estimated that no local authority area in England is likely to be entirely free from FGM (NHS England, 2018).

200 million women and girls are currently living with FGM/C in 31 countries around the world (WHO), with 68 million girls estimated to be at risk over the next 10 years (UNICEF).

However, we know FGM is notoriously hard to quantify. It is often referred to as “the silent killer”, as you could be sitting opposite a woman that has FGM and not know. She may not know the severity or what exactly happened to her and there is a serious problem with detecting existing cases of FGM in the UK in non-pregnant women.

Do you think FGM PTSD is prevalent in FGM survivors? And how can they cope with life afterwards?

FGM PTSD is definitely prevalent in survivors and something they have to cope with every day. Leyla Hussein, OBE- an FGM activist and psychotherapist who works alongside The Vavengers - has spoken openly about her experience with trauma. She was unaware of what FGM truly was, despite being a survivor, until the age of 21 when she met a nurse named Jennifer Bourne. Jennifer explained to her that the reason she faints during vaginal examinations is because of the trauma/flashback from having undergone FGM. This conversation prompted Leyla to start The Dahlia Project - the first such counselling service for survivors in Europe.

Tell us more about the Vavengers as a charity and what you do. Why did you both originally start it?

The Vavengers exists to support survivors of FGM/C and prevent the practice from happening to other women. Hoda and I founded the organisation to tackle the silence in both the practicing and non-practicing communities. From my point of view, everyone I came across in my own community (which doesn’t practice FGM) had no idea about it. It was shocking, it's like Pandora's Box. When you begin to understand the lack of data, lack of services and how many women are most likely living with the practice in silence, we simply had to join forces to do something.

Hoda had already been working in the space for over a decade, and I was new. The combination of expertise and fresh energy is how The Vavengers was started. We began mobilising artists and other activists to create work and speak out about this practice. Now our focus is on community work led by our partners or 'Community Ambassadors' as we call them, and advocacy to keep inviting people into the campaign to learn and speak out against the practice.

How has the Vavengers evolved during the COVID-19 pandemic?

We re-shifted the focus of our community work to not just support survivors of FGM/C but also those affected by domestic abuse, and undocumented asylum seekers and refugees who are adversely affected by the restrictions of the pandemic. It is very important to us that we respond to the needs of those we seek to help, FGM often sits at the intersection of many other issues affecting women here in the UK. Whether they are unable to work due to their asylum seeker status, don't have access to health services due to language barriers, or confidence in speaking about their FGM. COVID-19 really broadened our understanding of the multiple forms of adversity that affect not only women, but the men that they share their lives with.

We now ensure we look at our work holistically. Can you imagine not having enough food to feed your kids because you're unemployed? In those situations, we cannot expect people to come to a workshop that simply focuses on the damaging physical effects of FGM. It would be tone-deaf and inappropriate. We’ve therefore broadened our scope to focus on their immediate needs. To learn and fully grasp this has been a positive outcome of COVID.

There are definitely stigma’s linked to FGM, how do the Vavengers go about changing perceptions and educating people on FGM?

The Vavengers is made up of people from all walks of life, from both practicing and non-practicing communities. By operating in this way, we are breaking the stigma in the UK that FGM is ‘not our problem.’ Survivors should not be responsible for healing their trauma alone.

We also seek to debunk the myth that ‘FGM is a cultural practice’ and the idea that it should be ignored for that reason. If a remote community somewhere in the world was chopping off children’s hands because it was ‘a cultural practice’ the Western world would respond (rightly so) in utter uproar. But because FGM is affecting women’s genitalia, there appears this dangerous wall of silence which we hope to shatter.

Who are the best people you’ve met or worked with since launching?

We recently opened a V-Hub in East London where we have created a community of remarkable artists, activists and filmmakers to share the space with are wonderful to work beside and inspire us endlessly. Inside the space we have the Action For Sama team who are committed to protecting hospitals in war zones and includes the Oscar nominated Syrian filmmaker Waad al-Kateab. Our community ambassador Sarian Kamara works tirelessly to support the beneficiaries of our project in Peckham which supports asylum seekers, refugees and victims of domestic abuse. Dylema - of the Dylema Collective - is our creative ambassador committed to using her platform to empower women. But importantly, at The Vavengers we do not work hierarchically so it really is impossible for us to pick a best. Everyone in our close orbit, and who we meet through this work are superhuman and work tirelessly to benefit the lives of others. Every teammate, community ambassador, partner, survivor and colleague brings unique attributes to the campaign.

Do you feel like there is a lack of medical care for FGM survivors in the UK? Do we need to make a move to decolonize not only the training of professionals on the medical care that FGM survivors need, but the actual medical curriculum as well?

Yes.

In the UK, a range of policies and protocols around FGM prevention and care have been developed over the last decade. These include safeguarding procedures, the Serious Crime Act 2015, mandatory reporting of girls at risk of FGM/C and the FGM Enhanced Dataset. However, in medical contexts, the process for detecting and logging women who are identified as having FGM is still flawed. Many women fall through the cracks and are not identified as having FGM until they go into labour. This prevents them from getting the necessary support and care they need.

Are you aware that England has eight National FGM Support Clinics (NFGMSC), which are holistic, community-based clinics which offer a range of support services for non-pregnant women? They were created because non-pregnant women with FGM often fall through the cracks and specialist clinics are much better at properly recording FGM cases.

When cases of FGM are identified, during primary and emergency health care visits, women are referred to a gynaecologist - or if possible - to an FGM clinic. FGM clinics are much better at properly recording FGM cases (as it justifies their existence), but a gynaecologist/GP/doctor may not input the data into the system as it is not a mandatory requirement and there is no ‘punishment’ in place for not doing so. Lots of GPs also don’t ask all women about FGM (they may feel it is insensitive, or that they’re not properly equipped to do so) so some cases go undetected.

It has been reported that only 2% of GPs input full data into the FGM Enhanced Dataset (Karlsen paper on safeguarding.). Evidence from health professionals from 2017 indicates that they lack confidence and competence in caring for, and talking about, FGM, with many women going undetected in maternity settings until arriving at the labour ward.

The medical community desperately lacks a standardised approach to broaching the subject of FGM amongst patients. This demonstrates the cyclical and damaging nature that stigma can have, on reporting the problem, acknowledging its scale, and helping communities affected by it.

Medical Curriculum:

●  Our current curriculam and healthcare system continue to reflect a longstanding colonial legacy that sees Black and Brown Bodies as the issue, instead of systemic racism in healthcare (All4Maternity 2020).

●  As patient populations grow increasingly diverse and complex, ‘decolonising’ calls for modernising materials, create awareness of unconscious biases and the removal of colonial references (Gishen & Lokugamage 2018).

●  This need can not only be seen in the disparities in maternal mortality seen in the UK (FiveXMore), but also on the need for university curricula to address problem areas in midwifery programmes.

●  For example, the models used in skills lab are concentrated on the white ‘ideal gynaecoid type’ even though pelvic shapes vary between geographical regions and within the same populations (All4Maternity 2020).

●  Such standardisation of midwifery education may perpetuate a lack of awareness, and in turn lead to failures in highlighting differences in women.

Here’s a quote from Professor Gurch Randhawa: “unless all ethnic communities are included in research, the medical profession will never be able to develop culturally competent diagnostic tests and services—and therefore can’t deliver true equity in healthcare.” (Lilian Anekwe, “Ethnic disparities in maternal care”, (British Medical Journal, 2020;368:m442)

How can C Word readers support and get involved with The Vavengers?

Donate, share, follow. Follow @thevavengers account on all social media platforms and stay tuned for informative and educational campaigns on these issues. Share the stories we post. Donate on our website www.thevavengers.co.uk.

What is next for you guys, is there any campaigns that we need to know about and look out for?

The Vavengers is currently launching a ‘What if You Knew’ pilot campaign which discusses the health inequalities facing non-white women in the UK. Once our initial three videos are out (with Leyla Hussein, OBE - Janet Fyle, MBE - Aissa Edon, midwife, activist and FGM survivor). We’ll continue the series with more inspiring speakers.