Understanding FGM in Birmingham Nasheima Sheikh Khadija Jaamac

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

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

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

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)

FGM in Birmingham’s migrant communities Demographic data has demonstrated that Birmingham’s emerging immigrant communities come from areas where FGM is practiced, including Somalia, Ethiopia, and Sudan

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.

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.

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 < 5 Gambia 13 Kenya < 5 Iraq < 5 Somalia 20 6 50 76 Sudan 9 9 Yemen < 5 6 > 6 Unknown 133 Total 44 12 74 263

PEER Methodology • PEER • Training • Data collection • Data analysis

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

Qualitative Themes

Life in Birmingham • General positive views • English viewed as very important to independence • Some areas of difficulty: • Immigration/asylum seeker status • Language barriers; “[they] can’t speak to [the] doctor, police, employment centre and schools…utility company [to] sort out bills and housing” • Family structure; “In Somalia, we have close-knit communities that help each other out. ”

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

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

What communities say about FGM • What constitutes FGM • ‘Sunna’ – Type I/Type IV circumcision “little nick” “no big deal” “doesn’t hurt her” • ‘Pharaoni(c)’ – Type III circumcision “bad” “not allowed by our religion” • Culture of silence; “It’s all a bit 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’. “

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, she’s like a doll – she doesn’t 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 don’t discuss it]. ” • Older generation; “UK girls are out of control”

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

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’

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

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. ”

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

Effects of circumcision on women’s 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 can’t go to her work every month. ” • Sexual wellbeing; “Men say that women just lie there during sex. Men feel their circumcised partners don’t feel anything and they don’t like that anymore. ”

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 sister’s suffering seriously. Is it because we are less humans? What if we were rich or different race, would they have investigated my sister’s pain quicker? ” • Lack of awareness and information for both women and health staff and need for informed questioning

Birmingham’s 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

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

The role of advocacy in FGM • Difficulty identifying allies in the community • Older generation; advocating on FGM is “young people’s territory” • Younger generation feel unaware and/or unskilled to engage in targeted and effective advocacy efforts • Preferred leaders and approaches

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”.

Take home messages Voices of women: Khadija. .

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

Take home messages • Women not aware of FGM as child abuse; don’t 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

BSWA CONTACT DETAILS Telephone : 0121 685 8687 Helpline : 0800 0732 606 Nasheima. sheikh@bswaid. org Khadija. jaamac@bswaid. org