Oral evidence: Female genital mutilation , HC 1091Tuesday 6 May 2014

Oral evidence, 6 May 2014.

Witnesses

Obi Amadi, Community Practitioners and Health Visitors Association, Dr Kerry Robinson, Consultant Paediatrician, Whittington Health, and Dr Comfort Momoh MBE, African Well Women’s Clinic, Guys’ and St Thomas’ Hospitals, gave evidence.

Chair

Thank you very much for coming here to give evidence. Some of our questions will be a repetition obviously, because the subject matter is of interest to this Committee and some of the questions need to be put to all witnesses, but we are most grateful. If I could come to you, Obi Amadi. We have come to the end of our inquiry, although we will be making some field visits. One I hope will be to St Thomas’ to have a look at your clinic, Dr Momoh. We are very keen to go out rather than just sit in Westminster. Because it is only across the river, of course, it has taken months to arrange this, but we will do this. What struck me, as someone who knows very little about this subject and knew very little until we began our inquiry, is this seems to be a complete car crash. Here you have a very firm law. You have well meaning professionals, all wanting to do something, but at the end of the day it is continuing day after day after day. Are you satisfied, as far as members of your organisation are concerned, that they have the tools and the ability to report this horrendous crime and to get something done about those responsible? Ms Amadi?

Obi Amadi

In my response to you I would say that there are some health professional concerns in terms of being able to fully address this issue. We would not be at the stage that we are now without the help, the stories from the people who have been subjected to FGM, and for that I would like to thank them because otherwise we would not be having this discussion today, right now. In terms of health professionals, there are a range of things that I think have created the car crash that you describe. I think there is an ignorance in terms of the real repercussions of FGM in terms of health professionals. There are problems around the reporting and recording systems that we have that makes it sometimes something that health professionals do not always see as a priority and address in the way that they should. They—

Chair

But as far as your members are concerned—because we have heard from the other professionals over the last three months—are you satisfied that they know enough about this and are reporting it? We took evidence from the police last week and they were very clear that there were not the kind of referrals that they would have expected. They need the referrals to do the prosecutions, not the other way around. Are you satisfied that this is happening among your—

Obi Amadi

It is not happening enough. It is not happening the way that it should.

Chair

Tell me what your members should be doing.

Obi Amadi

In terms of when they meet and they are giving care and services to women who may be at risk, or the women who have children who may be at risk, there needs to be more diligence applied in terms of the questioning, the flagging up and the referring on of these women who are at risk. One of the problems in terms of health visitors—because if I speak from the health visitor and the school nursing perspective—it is not always reported by the midwife, so the health visitor is not always aware. In terms of the prevalent countries where FGM is practised, for some health visitors they are not aware of what those countries are. So the level of information—

Chair

You are saying there is a huge awareness problem before we get on to anything like referral?

Obi Amadi

Yes, there is.

Chair

Dr Momoh, you have obviously done a huge amount of work. You are widely respected in this field and we have seen all the statements that you have made and all the positive work you are doing at your clinics. Do you accept what the Royal College has told us, which was basically, “If it is 16 years old we cannot do anything about it now and, therefore, we will not really refer” or do you think every single case needs to be looked at very, very carefully no matter how long ago it was that it happened?

Dr Momoh

I guess we need to review all cases. I think the problem we have had is we are not having a joined-up approach, which has been the case. We need to work together and have a multiagency approach if we need to do anything around FGM. I would urge that we review all cases. Obviously we need to raise more awareness because from my own experience in working within health, I would say perhaps 50% to 60% of health professionals are unfortunately still unaware of how to refer cases to health visitors or to social services. Also, we all need to know what our roles and responsibilities are. We need clarity on that. I have been trying to work very closely with social services within Lambeth and Lewisham where I work, but it hasn’t been very successful because they are not aware of what their roles and responsibilities are. Each time they say, “Even if you refer cases to us what are we going to do? We don’t have the capacity and we don’t know what to do. We need a clear—”

Chair

Direction.

Dr Momoh

Yes, pathway if you like.

Chair

Therefore, do you feel that there ought to be statutory referral and that people who see this happening need to refer it on as a matter of law; it needs to be mandatory?

Dr Momoh

I guess there needs to be mandatory reporting. That is why we have been working with the Department of Health so that we can have robust data; so that we can have a clear pathway. At the same time, we need to know who we are referring. Are we referring all cases to the social services or to the police? That needs clear direction because from my own experience and also from working with other colleagues, what we have come up with or what the consensus is that it is mandatory to report all pregnant women obviously rather than gynae or women coming with gynae cases or to the clinic or family planning.

Chair

Indeed. To give the Committee an idea of your average month at St Thomas’ or Guys at your clinic, how many cases would you see of FGM now in a typical month? I know there is no such thing, but give us some figures on this.

Dr Momoh

Yes. It varies. Typical months on an average perhaps about 38 to 40 cases every month, and we see pregnant and non-pregnant women obviously. The non-pregnant women come for various reasons.

Chair

You endorse the view that this is going on as we speak; somewhere in London FGM is being committed against a young girl?

Dr Momoh

I believe so.

Chair

Dr Robinson, did it come as a shock to you and your colleagues when one of your colleagues—we are not going to talk about the case but whatever is in the public domain—was prosecuted at the Whittington Hospital for FGM?

Dr Robinson

So the question is was it a shock? Yes, that was a shock but the specifics of the case are yet to come into the public domain.

Chair

Yes, we know, we are not trying the case here. This is therefore happening, as Dr Momoh has said, in every hospital in London. You are getting cases of this kind coming before doctors and to casualty on some occasions. Yet they do not seem to be being referred on, so we have the police telling us, “We could do much more if only we had more referrals”. What stops people referring on these cases?

Dr Robinson

From a paediatric perspective, I think there is a lack of awareness. There is a lack of awareness about FGM. There is a difficulty having the conversation. There is a time issue in the way that we practice. You cannot always have that sensitive conversation, and certainly, if you are not used to using that language in a quick 10 minute consultation, to suddenly ask about cutting when you might be seeing them for a respiratory tract infection is tricky. So there is something about education. There is something about the setting. But I think the infrastructure with a referral to social care is there. Female genital mutilation, or cutting, is child abuse and we have good infrastructure for child protection within the world of paediatrics. If it is seen within that context, then the pathways of referral and information sharing are there. So, if I talk about the cohort of patients of children that we have collected at University College Hospital—

Chair

Over what period?

Dr Robinson

Collected data from 2006, so up to date that is eight years. We have had 34 children that have been referred. 10 of those had had no FGM and 24 had had FGM. So this is just children under 16. Of those that could have been referred, i.e. it was within the law post-2003, then seven were referred to the police but none of them have gone forward from there. We don’t always get the feedback but the thinking is that the police do not have the evidence to prosecute because it is incredibly difficult to get a child to speak out against their family because FGM is done within the context of a loving setting.

Chair

We understand all that and that is very helpful to remind us of that. But what is interesting about what you have said is three points: first of all that the number is so low. It is only 34 in a hospital like the University College Hospitals. Secondly, that the police have not come back and told you why and you would like to see more feedback. You say it is working, but is it really working? Until you got to the prosecutions at your hospital 20 years have gone by and absolutely nothing has happened by way of a prosecution. How can it be working when we have been given figures of thousands and thousands of girls and women in the UK having been subjected to this?

Dr Robinson

Sure. So it is not working. What we don’t know is what we have prevented. Prosecution is only one top-down infrastructure. There should be a bottom-up approach as well that has been talked about in these settings: education across the board, engagement of community workers, engagement of appropriate people to talk to both men and women within practising cultures, across the board education in schools, both in primary and secondary tiers. People who come to hospital are only a minority of the population, so there are—

Chair

Sure. It is the GPs who would probably see many more of these cases.

Dr Robinson

But the point I was thinking about when the GP was talking was that to identify female genital mutilation in a child is incredibly difficult, even for a paediatrician who looks at children’s genitalia on a regular basis. Often there is nothing to see, so type 4 you do not even see it. You do not see that and in several of the cases that we have seen there is nothing to see even when examined by a specialist. Also the changes over the course of puberty are difficult to identify. So I think it is not right to expect a GP to be able to identify those changes.

Chair

That is very interesting. Finally, from me, in terms of statutory changes, Obi Amadi, should there be a change? You think this should be done on a statutory basis, do you?

Obi Amadi

I think there needs to be some strengthening of this. The level of awareness that would go with that would I think be most helpful in terms of increasing the number of cases that are reported.

Chair

Dr Robinson?

Dr Robinson

I think that the infrastructure that we have in place is enough. I think that education is more important, raising awareness, a poster in every healthcare setting telling people who to go to, who to contact if they are worried, a campaign across the board.

Chair

Thank you. Dr Momoh?

Dr Momoh

We need to raise more awareness and also we need to work directly with the community. It is very, very important.

Chair

Which is perhaps not happening at the moment. We have had Leyla Hussein and others obviously coming in and there is a lot of work to be done.

Dr Momoh

We need to improve in that. Yes, definitely.

Chair

Thank you.

Mr Winnick

The multiagency guidelines obviously are meant first and foremost for health professionals, as one would expect. But the point is made that they should also apply to teachers, social workers and so on. There was a survey carried out by the National Society for Prevention of Cruelty to Children, which said that many professionals lacked understanding and knowledge. But when it came to a YouGov poll last year about teachers and FGM, it found that seven out of 10 teachers—so this is a poll, which may not be accurate—said they were not aware there was Government guidance on how they should be dealing with FGM at their school. One in six teachers said they did not know that FGM was illegal in the UK and that there was a legal duty on them to take action to safeguard children at risk. Does any of that come as a surprise to you; that there remain so many teachers who are not aware of the problem?

Dr Momoh

Not at all to me, but it clearly demonstrates that there is a lack of awareness and it is similar to health as well because although we have the multiagency guidelines, we have the professional body guidelines, but professionals are not aware of these guidelines. I think we need to do more to point them to these guidelines. The guidelines are there. They are there to support us as professionals, as frontline providers, but half of us are not aware of these guidelines. I know that from some of the research or scoping that I have done recently.

Mr Winnick

Is that your view?

Dr Robinson

I would echo the same. The guidelines are in place. It is about using them. It is about education for professionals, consultants down to juniors within the world of health.

Mr Winnick

How far do the three of you feel that there still remains a—how can I describe this—cultural reluctance, not necessarily accusations of racism as such, but a feeling that one has to be ultra-sensitive and therefore hesitate to take the sort of action that obviously needs to be taken? Do you think any of that remains among doctors and other professionals in the health field?

Obi Amadi

I would say it does, unfortunately. I think that again with more education and more clarity about the issue, health professionals will feel much more confident about addressing it and not think, “If I raise this with a woman, people will think that I am being racist”. Once you are very clear about what the issue is and the fact that this is about protecting children, the voice of the child that we don’t hear when they are so young, the health professionals should not have any problem. There should not be a conflict. It should be a straightforward thing to do.

Mr Winnick

Dr Robinson, to be blunt about it, does this sort of ultra-sensitivity exist among some white professionals, wrongly as we all know and you are the first to say this?

Dr Robinson

I think less so with increasing teaching around child protection and teaching professionals how to have that conversation in simple, straightforward language. Before there was the campaign around domestic violence, people found that a difficult conversation to have. If you put it as part of your history taking when you take a family history as a standard question to ask, “Are you related to your partner?” which if you ask a white Caucasian they think you are mad but it is a routine question that you ask or, “Is there any domestic violence?” “Does your community practise cutting?” then the sensitivity is taken away. So, yes, to a degree, but getting better.

Dr Momoh

I think we need to move away from the sensitivity issue. If we see FGM as child abuse, we all need to work together and safeguard girls and young women who are at risk, so we need to take that sensitivity barrier away.

Mr Winnick

Child abuse?

Dr Momoh

It is child abuse and that is what it is.

Mr Winnick

My last question is one I put to the previous witnesses, namely do you think it would be useful to have advertisements on television and elsewhere, making this even more of a prominent issue?

Dr Robinson

Yes, definitely. Raising awareness of practising communities, that it is illegal and it is child abuse would be great.

Dr Momoh

Could I add to that? I think so as well. I just came back from Nigeria. I was doing a scoping visit or scoping exercise and one of the advertisements that was around is “Clitoris is a gift. Don’t mess about with it” or something, so we need something like that out there. We need to have a global and exciting advertisement out there so that it will raise people’s awareness. People will be aware of FGM and know the consequences and ill effects of it, so to me we need to flag it out there.

Mr Winnick

I think a good amount of that could be done in Nigeria at the moment.

Obi Amadi

I agree completely. The information in the advertising also needs to very clearly say where you can go, how you go and the fact that there is somewhere safe that you can go to speak and have your issue dealt with.

Chair

Dr Momoh, was that a Nigerian Government advertisement or was it by one of the—

Dr Momoh

I think it is a local advertisement and they are out there trying to raise more awareness and work with the local communities.

Chair

The figures from some of the west African countries are horrendous in terms of FGM and even higher than Nigeria, are they not?

Dr Momoh

In Nigeria, although it says 30% to 40% prevalence, because of the population size it is the largest in the whole world apparently. Nigeria has a population of about 160 million to 166 million, so it is very high.

Chair

It is a very large figure.

Mr Clappison

As a matter of pure curiosity on the Nigerian point—and I haven’t visited Nigeria—Nigeria’s population is divided roughly between the Christian south and the Muslim north. Am I right in imagining that it is not prevalent so much among the Christians in the south and it is more of an issue for the north?

Dr Momoh

Not really. It is both.

Mr Clappison

It is both, is it?

Dr Momoh

Yes. From the scoping exercise, it happens in the south, south-west.

Mr Clappison

So it is a widespread cultural thing.

Dr Momoh

It is, definitely.

Mr Clappison

Could I ask each of you in turn if you think the standard of services for women who have undergone FGM is good enough and is there anything else you think the Government should do to improve them? Perhaps we will start with Obi.

Obi Amadi

There are sometimes issues with access to specialist services available to women because maybe there are not enough specialist services set up. Also, apart from dealing with the physical, there needs to be a good, strong psychological service so that women have somewhere that they can go to and be treated without a time limit, “And then we can’t see you anymore”. It has to be something that is substantial and meaningful.

Dr Robinson

I would echo that. I am a paediatrician, so obviously I come from services for children of which there are very few. The service at UCH works with the well women’s service. So it is limited and I also echo what was said that it is the long-term psychological, mental health consequences that are not catered for. So it is much more commissioning of services and also for the commissioners to understand the problem, which is why data collection is so important. We need services and we need commissioners to understand the problem so that the appropriate services are commissioned.

Dr Momoh

I guess we need more clinics. I run one of the few clinics that we have here in the UK—I think we have about 15—and we have women having to travel from Manchester and Bristol to my clinic. It would be very good to have clinics in different cities and areas. I echo that psychological wellbeing is very crucial and very important. Coming to seek help, from my experience of working with women, brings flashbacks. It brings memories, so these need to be addressed and supported. I think I will slip this in: I am off to Ireland tomorrow to launch the first FGM clinic in Dublin, which is good.

Mr Clappison

In your clinic’s evidence you said you were seeing 38 to 40 cases a month. Are those new cases?

Dr Momoh

Some are new cases but mostly follow-up, like pregnant women who are coming to have their second babies or subsequent pregnancy. Again, we need to see them to give them necessary information, address issues and readdress legal issues as well.

Paul Flynn

I think your evidence has been very helpful. What I would like to ask—and I know this is possibly outside your expertise—is do you have any ideas of how we break down the cultural loyalty in these communities to this practice? It is very difficult to get across that what has been happening to them for generations is very undesirable. Have you any ideas of how this might be done?

Dr Robinson

There are pockets of good practice and there are community workers who have gone into local communities and held focus groups, with both men and women. We know from the UNICEF report that it is beneficial for men and women to talk to each other. Often each sex does not know about their partner’s attitudes towards FGM, so it is to get people talking about it within their own community and for them to meet people who have not been cut, because often they think that is not a good thing, from my understanding. It is to meet people who have not been cut and to say that it is all right not to be cut, for people to have role models in other ways rather than the generational expectation that you will be cut. But it is also education. Everybody in this country goes to school and compulsory sexual education in both primary and secondary school would be a way forward, not just to teach the children but to invite their parents in before you teach a child. You could say, “We are going to have this workshop on FGM” but invite the parents the week before so that they know what the authorities are going to teach their children and then that conversation is had at home, to break it down into an education thing.

Paul Flynn

It is very difficult to persuade adult Somali women and men to mix together on social occasions when they are strictly segregated. To get them together to discuss this I would imagine would take a great deal of persuasion.

Dr Robinson

It does but it has happened. There are pockets of good practice where it has happened that probably Comfort knows better than me.

Paul Flynn

Where are the good practices, apart from in France, which we are going to hear about later?

Dr Momoh

They are doing fantastic work in Bristol.

Paul Flynn

Could you let us know what is happening in Bristol, from your perspective? We have heard from Bristol, but what is your view of it and is it something that we can emulate elsewhere?

Dr Momoh

I guess so in terms of multiagency work and the multiagency approach, the schools, the health, and also they have the national action plan. For good practice I must not forget my area, Lambeth, where we are doing fantastic work, not because I am from Lambeth or because I work in Lambeth. We have the national action plan and we meet regularly and we not only look at FGM but we look at violence against women as a whole. To answer your first question, in terms of what to do I think we need to mobilise everybody. We need to work together with young people. We need to empower the young people. We need to work with the older generation. As you have rightly said, it is very difficult to change their mind-set and their attitude, but we need to work with everybody. The young people are going to be the future generation. We need to be able to empower them and to feel comfortable in addressing FGM as well. We need to work with the religious leaders. If some believe it is a religious obligation, we need to demystify that issue. Also we need to work with the community leaders as well.

Michael Ellis

Do you think that with respect to monitoring of the FGM risk there is a case for separately identifying the risk of FGM in personal child health records, the red book that is given to parents? Do you think there is a case to separately identify it in that way? Should there be a statutory duty on health visitors to ensure that this information is included in the GP’s computerised notes for mother and child? I would be interested in your views on that.

Obi Amadi

I think entry into the personal child health record is perfectly appropriate. As we have heard earlier, people initially feel uncomfortable about asking particular questions. With the training and awareness raising, professionals will be much more confident in being able to raise that. In particular, the relationship the health visitor has with a woman is something that is built on, so they could have the subsequent conversations. In terms of mobile families, once it is there in that record it remains in that record. I know that there are people who say that the record will just disappear and get lost. They don’t go missing in other high risk notifications in personal child health records. From that point of view, I say yes. In terms of the GP and it being statutory, health visitors in their practice don’t necessarily have access to or work in GP environments to be able to do that. We are awash with different information data systems, so health visitors will have their child information system where they work and that usually does not speak to the GP system. It is one of those where we are caught up.

Michael Ellis

So you feel in your case that it is a yes to the red book but that it would be asking too much as far as health visitors are concerned to make sure that is placed on a GP’s records?

Obi Amadi

I think that would happen more easily if the responsibility was for the employer to have it happen, but it is less practical for the health visitor to have to physically drive to a centre, unless there is another way of getting that.

Dr Momoh

My own experience starts with the midwife because the midwife is the one who is going to give out the red book. It is very important that all midwives identify the risk and then notify it in the red book so that, once it is passed to the health visitor, the health visitor can in turn liaise with the GPs as well as social services. I think the midwives needs to know what their roles and responsibilities are for making sure.

Michael Ellis

Would you be confident that the red book would be sufficient?

Dr Momoh

Definitely.

Michael Ellis

It is respected in other areas sufficiently that if it was in the red book it would get followed through the chain?

Dr Momoh

We hope so, but it needs to be backed up electronically as well because the red book can easily be misplaced or get lost, which happens from my experience.

Michael Ellis

No system is foolproof of course. Dr Robinson, did you want to say anything?

Dr Robinson

I think there is a space in the red book within the family history bit where you can write that this mother has had FGM, but you have to think about the reason that you are writing it in red book. You are writing it to highlight that this child is at risk of the procedure. Documentation is obviously important, but the important thing is to have that conversation and ask the mother what her intentions are for that female child. It has to be really clear who is going to have that conversation. Whose responsibility is it? Is it the paediatrician when they do the health check, is it the midwife, is it the health visitor, and has that conversation been had? So, documentation is important but the most important thing is having that conversation and safeguarding the child.

Michael Ellis

It is very difficult, isn’t it, because none of these people are police detectives? They are having to ask questions that they may not feel comfortable asking and certainly the person being questioned may not feel comfortable in answering. It is quite an ask, isn’t it?

Dr Robinson

It is but, as we said previously, once you get used to having those conversations, if it becomes a standard setting, if you ask it to everybody, then it destigmatises it. If you ask it to your white Caucasian who you think is not going to have it happen then they might laugh at you but it raises awareness, so there is a role for that. But also you are having those conversations, so you are meeting a woman who has just had a baby. If you are the midwife you have been asking all sorts of questions around that, to then say, “You have been cut. Will you do that to your own daughter?”

Michael Ellis

It is more fitting.

Dr Robinson

It is.

Obi Amadi

Going on from that and just thinking about the example of it being asked across the board and people feeling uncomfortable about it, we had that problem in the past over sickle-cell until we had more and more cases of white people with sickle-cell disease. In terms of the child health record, we need to remember it is the child’s record so the mother’s status and the mother’s health should not be recorded in it. It is just about the child at risk not whether the mum has had FGM or not.

Chair

We will be hearing very shortly about the experience in France and, of course, Dr Momoh has been to Nigeria to look over there and see what is happening. From your point of view, Dr Robinson, do you think there is a sufficient exchange of information in London itself between the Whittington Hospital and St Thomas’ and Guy’s? This is obviously happening all over London as we speak, as we know. Doctors are very busy professionals. Where is the mechanism for you all to be able to sit down, other than at the Home Affairs Select Committee giving evidence, to actually talk about pushing the barriers forward on this issue? Is there such a mechanism at the moment?

Dr Robinson

Not specifically for female genital mutilation, cutting, but if it is seen within the child protection infrastructure then health professionals do liaise. There is supervision for child protection, certainly for paediatricians, that is not necessarily pan-London but sector-wide and so difficult cases are discussed. If a case is seen within the infrastructure of a child protection situation then there is a forum to discuss it, but I don’t think there is enough sharing of practice specific to FGM.

Chair

Ms Amadi, as far as your organisation is concerned—you have been invited to give evidence here—are you called upon by the Royal Colleges to be part of a dialogue on this issue? Have you ever been asked, as an organisation, your views as to how you would fit into the jigsaw that is the prosecution system?

Obi Amadi

Our organisation is part of the intercollegiate group that put together the recommendations and we have had those discussions in the past leading up to the production of the report, so we have had some of that discussion and debate.

Chair

But that is discussion and debate. We are talking about practical cases. Is there a proper exchange of information on practical cases on a regular basis?

Obi Amadi

I would have to say that it is lacking. It could be better.

Chair

Dr Momoh, if you were looking at one way in which perhaps the doctors could improve reporting what is happening, what would that be?

Dr Momoh

I think, as you have rightly identified, everybody speaking together, which is really lacking. Exchanging expertise, information and knowledge is lacking, although I get involved with raising awareness in conferences. That is not enough. Maybe we need to set up a pan-London or national forum where we come together maybe once a month or bimonthly to discuss issues and real cases and how we can move things forward. That is lacking at the moment.

Chair

I understand that your clinic does a lot of reversals of FGM. Is that right?

Dr Momoh

We do.

Chair

I think the figure was given of 350 women have had reverse procedures.

Dr Momoh

Is that per year?

Chair

Is it more than that?

Dr Momoh

It is about 75 to 80 reversals or deinfibulation per year.

Chair

Do you ever come across a case where you have performed a reversal where the woman comes back, having had another procedure for FGM?

Dr Momoh

If I can remember, we had one case when the clinic first started. The clinic started in 1997 and I think we had one in 1998 and she denied that she had had reinfibulation. We have had one case.

Chair

Dr Momoh, Dr Robinson and Ms Amadi, thank you so much for coming in to see us. It has been extremely helpful evidence and we are very grateful indeed.

Dr Momoh

Thank you for inviting us.

Chair

We will be visiting your clinic, Dr Momoh, in the near future.

Dr Momoh

That is fine. You are welcome. Examination of Witnesses

Witnesses

Linda Weil-Curiel, Lawyer at the Paris Bar, Dr Emmanuelle Piet, French gynaecologist and County Medical Officer of Seine Saint-Denis, and Agnes Bangoura, Interpreter, gave evidence.

Chair

Let us go to our final witnesses on our FGM inquiry, Linda Weil-Curiel and Dr Emmanuelle Piet. Bonjour. Merci beaucoup. Thank you very much for coming here. They are probably the only French words spoken at the Home Affairs Select Committee. We are most grateful to you for coming here to give evidence to us. We have heard a lot of witnesses over the last eight weeks and I have been over to Paris where I have met both of you to talk about what is happening in France. This is a unique opportunity for this Committee to hear about what you are doing in France from your point of view, Linda Weil-Curiel, about the prosecutions that you have undertaken, which we are very interested in compared to our prosecutions, and from your standpoint, Dr Piet, how as a gynaecologist you are able to refer cases to the appropriate authorities. If I could start with you, Linda Weil-Curiel. I am not suggesting you are an expert on our methods of prosecution—and I know you are not—but why have you been so successful in being able to prosecute so many people responsible for FGM? I think it is over 100 separate prosecutions of cutters.

Linda Weil-Curiel

It is a bit difficult to explain because our systems are so different, but it all began because babies died after the procedure and of course you can’t turn a blind eye to the death of a baby. When the first case was reported, nobody knew about the practice itself in France. It was in 1978. The Senegalese woman who was responsible for the death of the baby was tried for causing death to a baby but it was not considered like a volunteered act, an act that was wanted. Nobody heard about it because it was not a case that was reported, but in 1982 another baby died, little Bobo Traore aged three months. She was cut at her parents’ home and the baby continued bleeding. The parents did not want to go to hospital or seek medical help and the baby died three days later. When the baby had died, the father did not know what to do with the corpse so he called an ambulance and went to the hospital and then the cause of the death was found out. The parents were prosecuted for not giving assistance to someone who needed it.

Chair

It was a particular offence that was used, which was not FGM but a particular offence.

Linda Weil-Curiel

No. This is when I stepped in and I said, “Excuse me but before not giving assistance to this child, there was the voluntary act of cutting and this is mutilation”. This is among the highest crimes in our penal code.

Chair

The mutilation of an individual?

Linda Weil-Curiel

Yes, mutilation. I said, “You should prosecute under this qualification”, and this has been my personal battle, I am sorry to say. I did not want to come forward but I had to fight the prosecuting team because they said, “No, come on, you are not going to take a big hammer to squash a fly. Prosecuting is enough for these people”.

Chair

Yes but you found what you regarded as the right way to prosecute. How easy is it to convince? You have told us about your battle with the prosecutors. How many cases of successful prosecution for FGM have there been in France?

Linda Weil-Curiel

For my part—because we know of only two prosecutions and trials that I was not in; it was in Provence, outside Paris—I counted them before coming and I believe it is 43 and over 100 parents.

Chair

Over 100 parents have been prosecuted?

Linda Weil-Curiel

Yes, and punished.

Chair

Do you think these prosecutions, now that they have occurred, actually help to raise awareness to stop other parents doing this?

Linda Weil-Curiel

Yes. This was one of my aims, not only that the prosecution should be aimed at the right criminal qualification but I thought this is a way to lift the taboo. A trial in the highest criminal court, the assizes court, always gets a lot of publicity and there was something new about these trials and that sent a message because they all listened to the news and they knew, “Oh my god, if we do it and we are pinched then this is where we will end up”.

Chair

It started with the death of a baby and it ended up with this massive awareness about what was happening. Dr Piet, you said something very interesting recently. You said, “People talk of culture and tradition, but children have a fundamental human right not to be mutilated. It is racist to think otherwise. Can you imagine the outcry if this was happening to white, blonde girls?” Why did you say that? What was so important about making that statement?

Dr Piet (Translation)

Just because when we started taking care of female FGM we said it is sexual because it does not prevent anything on the genital but it prevents any pleasure for the women.

Chair

I think you will have to say your sentence and then the interpreter will speak, not simultaneously, because it is easier for us.

Dr Piet (Translation)

In French we have chosen to call it sexual mutilation because it prevents mainly the pleasure not the sex itself. I work in a borough of Seine Saint-Denis. There are 1.5 million inhabitants and 42 nationalities, and 16% of the women from these nationalities were mutilated. All the ladies that gave birth in the hospital in that borough were mutilated.

Chair

All the women?

Dr Piet (Translation)

16%. We have worked for the prevention of FGM for 40 years now. At the beginning, the GPs had a lot of problems knowing what FGM was, because they were saying, “It is their customs. We should leave them alone to do this”. That is when I entered into action. We started working with them, but when the immigrants came to France they started mutilating children between zero and six years old. They were saying these children are not going to talk and they knew that it was a crime to do it. From that point, we talked to all our health professionals, telling them to be aware of all the different mutilations and check the children between the age of zero and six.

Chair

What Dr Piet is telling us is that the lack of awareness among the professionals themselves allowed this to continue in the way in which it has.

Dr Piet (Translation)

We trained the professionals, telling them that it harms children, it is risky, it just hurts them and it is forbidden.

Linda Weil-Curiel

Excuse me, but there was something else that was added. Dr Piet called me in 1984 and she said, “Come and talk to my doctors because some of them are reluctant”. I said, “But it is against the law and if you do not do that and if you do not inform the prosecutor if you spot a child that has been mutilated, then the law will come on you because you have to inform them”.

Chair

So you basically said to the doctors that this was a crime that was being committed. If they just let it pass then the state would come after them, in effect.

Linda Weil-Curiel

Yes, because if you turn a blind eye then it is a very bad message that you are sending because you are contradicting what the doctors tell the mothers, “Don’t do it otherwise you will be prosecuted”. If you don’t inform the authorities when you spot that the child has been cut, then you allow the next little girl in this family to be cut, and not only in this family but in all the vicinity because people talk, “The doctor says don’t do it but he saw that my daughter was cut. He didn’t say anything so I am going to do it”.

Chair

Let me ask you about the examination of young girls in France, because it is very important. We have been told that this is not compulsory but it is by invitation. How important is it that there is this examination of young girls in France? There is a view in this country that we are concerned if the state was to force young girls to be examined. We understand that is not the position in France, but that they are invited to come and be examined by their doctors. Is that right?

Dr Piet (Translation)

We have in France free compulsory examinations. There are different stages where the children are examined: zero, nine months, 12 months and 24 months. All these examinations will then be sent to the GP.

Chair

Are those compulsory? Does every French child have to have this?

Dr Piet

Every French child, boy, girl, black, white.

Chair

They have to do it. What happens after two years?

Dr Piet (Translation)

After two years, it is not compulsory but it is required that all paediatricians look at the children and examine them just in case there is any FGM.

Chair

You wanted to come in, Linda Weil-Curiel. How important is this?

Linda Weil-Curiel

It gives the evidence of the mutilation. If a doctor spots a child that has been mutilated, the doctor will report to their own administration, but I say no because it will go down in the sense of administration. You report immediately to the prosecutor and then the prosecutor opens a case because it has a medical certificate saying this little child has been mutilated, but it is not sufficient for the case to come. Then the parents are called to the police station for interrogation and all the girls in the family are also brought to the police station and the police take them to hospital for gynaecological examination. That is how a case is opened.

Chair

That is very helpful. Other colleagues are going to ask you questions and they will be very slow when asking questions.

Linda Weil-Curiel

Yes, because it is not my mother tongue and I need to understand.

Chair

We are very grateful. You are doing very well so far. Merci beaucoup. I don’t think we could manage this before the French National Assembly, but Mr Winnick is a noted linguist and he will—

Mr Winnick

If only I could speak your language like you speak English so perfectly. As I understand it, you said over 100 parents have been prosecuted.

Linda Weil-Curiel

And tried.

Mr Winnick

What was the outcome when found guilty?

Linda Weil-Curiel

They always are found guilty, except one or two fathers who could argue and prove they were not there at the time of the mutilation. They were in Africa or elsewhere so they had no influence.

Mr Winnick

What was the court’s sentence in those cases?

Linda Weil-Curiel

It all depends, because our system is that the jury at that time was nine citizens plus three magistrates, professional judges. Together they all compose the court and they all decide guilty or not guilty and, if found guilty, the penalty. In the beginning, against my own will and wish, the penalties were suspended prison sentences but in my opinion it was not a good sentence because it sent a bad message. I know because of the African people I met afterwards and worked with. They said, “Everybody knew about this trial so we were all watching TV and when we saw the family walk out of court free then we understood that the French understood us”. So it was not a good penalty.

Mr Winnick

Have there been no prison sentences?

Linda Weil-Curiel

Prison but suspended.

Mr Winnick

But no one has actually gone to prison, because the sentences have been suspended.

Linda Weil-Curiel

Yes, prison but suspended.

Mr Winnick

If I could get the position right: not a single person has been put in prison so far?

Linda Weil-Curiel

Yes, they have been afterwards but at the first trial it was suspended. The magistrates, the judges, the juries did not know anything about FGM, so they had to come to—

Mr Winnick

Yes, I understand. How many people have been put in prison where there has been no suspension of a sentence?

Linda Weil-Curiel

I didn’t count but at least a dozen.

Chair

Maybe you can write to us. If you could let us have an email with that, that would be helpful.

Linda Weil-Curiel

Yes, sure.

Mr Winnick

Probably about a dozen?

Linda Weil-Curiel

Yes, but because our prisons are so crowded—I shouldn’t say this because it is public—

Chair

And it is England.

Linda Weil-Curiel

Yes, the channel between. Under a certain penalty, we know that they will not go to prison. It can be changed by electronic tagging.

Mr Winnick

I would like to turn to another aspect. In Britain the extreme nature of some of the political organisations in France is known. Is there a political aspect where, to put it bluntly, parties on the extreme right campaign on this?

Linda Weil-Curiel

No, it is not a political concern. It is not.

Mr Winnick

I note that you belong to a non-political organisation that is renowned for human rights, the International Women’s Rights League, and that has taken—

Linda Weil-Curiel

But it is not a political party.

Mr Winnick

No, I said it is a non-political organisation. Has this organisation taken a lead on this particular issue?

Linda Weil-Curiel

It was founded by and with Simone de Beauvoir in 1983 because these cases starting arising. The idea behind this is that men fight for their universal rights to be recognised but they neglect the fact that women are also entitled to the recognition of their rights.

Chair

Dr Piet, would you like to add anything in response to Mr Winnick’s questions? Do you want to add anything to what has been said by Linda Weil-Curiel?

Dr Piet (Translation)

In the last 10 years we have improved a lot in the surgery so this has encouraged the doctors and health professionals to talk to the ladies about FGM and also to help the women who went through FGM, especially on the traumatic side and psychological side of the effects. This has enabled us to have deep discussions with these women who went through FGM.

Linda Weil-Curiel

Can I add something?

Chair

Very quickly.

Linda Weil-Curiel

I wanted to add that two perpetrators have been sent to prison, one for five stiff years and the other one for eight. There is hope, because the one that was sent behind bars for eight years knew that I was responsible for that too and when they saw me on the TV the husband would say, “That is the one who we have to go against. That is the naughty one, the bad one”. After she had served her term in prison, then she started calling me and we started dialoguing. In the end, we wrote a book together and I am her lawyer against her husband who would not give her any alimony. She speaks out now against FGM.

Chair

That is very helpful.

Mr Winnick

You said the prisons are very crowded in France, and the Chair said it is somewhat like in Britain, but at the end of the day it is better, surely, that there should be prison sentences in some of these cases, that it would give the right message. Do you agree?

Linda Weil-Curiel

Yes. Stiff prison sentences. When parents are sent behind bars very many people say, “We are not going to try to cut our girls because we don’t want to end up there”.

Mr Clappison

Do you think the prosecutions that there have been in France have had the effect of reducing the numbers of FGM cases?

Linda Weil-Curiel

Sure, yes.

Mr Clappison

Can I ask one other thing that arises out of your evidence? You have told us about very young children, babies, having this procedure performed on them. The evidence we have heard is that in many cases in Britain it is older girls. Do you have any views as to how that could be tackled as well?

Linda Weil-Curiel

In the beginning we only found out about very small children but, of course, the older ones were not spared. It may be more difficult for the doctors here in England to examine children that are older. I understand that, but we have to find a way.

Dr Piet (Translation)

At the beginning in the early 1980s children between zero and six were mutilated. Then in the 1990s they were mutilated from two years upwards, and now the older ones, the 12 year-olds, are sent back to their home country to be cut and then come back.

Michael Ellis

First of all, can I congratulate you, Madame, on your leadership in this area? You can be very proud of what you have done over many years and you, Doctor, as well on the medical front. Can I ask you, as a lawyer, what is the average sentence that is being passed? I appreciate that it differs because of your system, but are you finding now that there is inevitably a sentence of imprisonment and do you have guidelines? In this country we have sentencing guidelines and usually judges will tend to sentence people within a certain range. Do you have that in France and are people being sentenced to a particular range of sentences?

Linda Weil-Curiel

It is difficult for me to answer this. We don’t have guidelines. I am a lawyer, I am a avocat civil. It is a system that you don’t have here. I am not a prosecutor but I team with a prosecution. I would say that maybe judges are sometimes embarrassed when they are not familiar with that type of case and naturally they would ring colleagues and ask what they think. I cannot say anything further.

Michael Ellis

In the cases that you have been involved with, what is the lowest sentence that you have seen passed and what is the highest sentence?

Linda Weil-Curiel

One year suspended, but the baby did not die. The stiffest is eight years, and for the mother two years stiff.

Michael Ellis

Was the eight-year sentence for the person who performed the mutilating act?

Linda Weil-Curiel

Yes.

Michael Ellis

Do the lower sentences tend to be for the parents of the children who have allowed the act to take place?

Linda Weil-Curiel

Yes, but I believe it is not fair because, as I say, the cutters come into the families and snatch away the children. It is the parents who are the worst culprits because it is their will. They pay for that. They hand over the child so it is their responsibility.

Michael Ellis

Do you think the sentences should be just as tough for the parents as it is for the people who the parents engage?

Linda Weil-Curiel

Equal.

Michael Ellis

Despite your long work over many years in this area and despite the practices of the French courts and system, is this still going on in France and, if so, how much is still going on? Do you think it is rare now or still quite common?

Linda Weil-Curiel

I believe it is rare now, but now the practice has shifted. Very many parents have abandoned the practice but those who really want it done will send the child abroad and it is very sad because they wait until the child is maybe 12, 13, 14. The kids are sent to the village. Of course they are very happy to meet their families, their cousins and so on. They do not know what they are going to go through. They are cut and sometimes married—I say this like that—which amounts to rape. I have had two cases like that. When they come back to France either they come back to give birth or, with the help of the French consulate, they can come back to France and then of course they are very angry so they go straight to the police and complain. But afterwards, as they stay within their family, it is very sad for them because then they realise that their family will be prosecuted. So there is this conflict and many girls will not talk now.

Michael Ellis

This is a point that I wanted to ask you about, because it is clearly easier for the authorities to prosecute cases where either a doctor has seen a baby who has been mutilated or where a young person makes a complaint. It is much more difficult where there is this conflict with the young person who does not want to complain against her parents. How do you resolve that and what recommendations would you have for us here as to how we deal with those problems?

Linda Weil-Curiel

One part is for Dr Piet to answer, but I know the answer she says. We are only dealing with minors under 18 and she asks all hospitals and clinics to be aware of girls under 18 giving birth and being cut. As they are minors, they should reported to the police.

Michael Ellis

I know that Dr Piet wants to say something but before I call her in, are you saying that if somebody is over the age of 18 you don’t prosecute those anymore?

Linda Weil-Curiel

It could be done, yes, but we are dealing with minors.

Michael Ellis

You deal with minors?

Linda Weil-Curiel

It is very seldom that grown-up women go through the procedure. They know better.

Michael Ellis

Does it happen that it happened to them as children but it is only coming to the attention of the authorities when they are over the age of 18?

Linda Weil-Curiel

Yes.

Dr Piet (Translation)

Ladies under the age of 18 will be examined and a doctor will report that. After the age of 18, even though they have been mutilated at the age of two, they can still prosecute up to 20 years after the majority of 18.

Linda Weil-Curiel

The statute of limitation.

Michael Ellis

We don’t have that in this country, but they have 20 years after 18. Thank you very much.

Paul Flynn

Thank you very much for this presentation. I have one question finally, briefly. There is a great gulf between the young women who were born in this country, or born in France and educated in France, and the generation that immigrated here. That great tension is there between the two. Is it possible to get over the conflict in the families towards exposing what is going on? Do you think that the prosecutions have done this and frightened the parents to a state where FGM will become a thing of the past?

Linda Weil-Curiel

I am not sure I completely understood the question.

Chair

Do you want Mr Flynn to repeat it? He will do so.

Linda Weil-Curiel

Yes. It is a question of generations.

Paul Flynn

A generation of people who were born here or in France and those immigrants who came across as adults and their culture is part of Djibouti or Somalia.

Linda Weil-Curiel

Yes, and the girls claim, “I am French. It can’t be done to me. My parents did not know”, but the girls want to ignore that their parents have been informed. They would rather think, “My parents, of course, were not aware of what they were doing to me” but, excuse me, the parents know exactly what is being done to the child and the harm that is being done to the child and they want it to be done. They don’t want to harm necessarily but they want the act, the cutting to be done. It is more comfortable for a child to believe that the parents did not know.

Paul Flynn

Dr Piet, do you have any suggestions based on the French practice of compulsory examinations that we could copy here? Do you think we should adopt the French system of ensuring that every child has the examination?

Dr Piet (Translation)

Outside FGM I also work on the sexual abuse of women and children. The examination of children, white or black, should be compulsory. Whatever happens, they need to go through this examination. For the wellbeing of the children, the examination of all their genitals and sexual parts is important and compulsory, so we advise everybody to do it. It tells the parents that if they are looking at something that is missing they will be aware of it because they have had the training and they will be able to report it.

Chair

Dr Piet, how do we stop this practice once and for all? Here we are, the United Kingdom and France; we have heard this is also happening in Spain and other countries of the EU. What is the plan to stop this happening? Why are our professionals, our doctors, in some cases not reporting this? Why did Linda Weil-Curiel spend so long battling with prosecutors? Why did you spend so long trying to make people aware of what is going on? This is heavy weather of something that really is quite simple. What can we do? What is your three-point plan to stop this?

Dr Piet (Translation)

It is very difficult in France to see the children having rights to integration and parents do not have all rights over their children. These are very recent notions. The cultural alibi has been something that has been used by all the communities and this has to be broken by training and laws.

Chair

Dr Piet, Linda Weil-Curiel, thank you so much on behalf of the Committee and those of us who follow these matters internationally. Can I commend you for the incredibly important work that you have done that has inspired this Committee to wish to take matters forward in respect of our inquiry? Do you want to say something?

Linda Weil-Curiel

Men are our allies and we should make sure that they are part of the whole educational thing. I have noticed in speaking with men that they will not go public. That is a problem with men. They are shy, let’s say.

Chair

Not on this Committee.

Linda Weil-Curiel

No, but they are shy. Very often they will say, “No, I wouldn’t have that done to my daughter because I know how my wife suffers from the procedure”, but they will not speak before other men.

Chair

Yes, we understand the point and we are very grateful.

Linda Weil-Curiel

We must have them with us.

Chair

Of course. Presumably, if the British ambassador in Paris, Sir Peter Ricketts, was to put organisations in touch with yourselves you would be very happy to meet with them and share this important experience.

Linda Weil-Curiel

Of course.

Chair

It is a very good example of UK-French co-operation.

Linda Weil-Curiel

I must say that the UK has taught me and us in France one thing that we have included in our law because I learned that the British had done it. It is the possibility to prosecute when it has been done abroad, not on a French or British national but somebody residing in England. We adapted it. I stole the idea and we have it in our law now, so thanks to England and the fighting spirit of England.

Chair

Thank you. To you, our interpreter Agnes Bangoura, merci beaucoup, thank you very much. Merci. Thank you for coming all the way from Paris. We are very grateful. Q454 Q455 Q456 Q457 Q458 Q459 Q460 Q461 Q462 Q463 Q464 Q465 Q466 Q467 Q468 Q469 Q470 Q471 Q472 Q473 Q474 Q475 Q476 Q477 Q478 Q479 Q480 Q481 Q482 Q483 Q484 Q485 Q486 Q487 Q488 Q489 Q490 Q491 Q492 Q493 Q494 Q495 Q496 Q497 Q498 Q499 Q500 Q501 Q502 Q503 Q504 Q505 Q506 Q507 Q508 Q509 Q510 Q511 Q512 Q513 Q514 Q515 Q516 Q517 Q518 Q519 Q520 Q521 Q522 Q523 Q524 Q525 Oral evidence: Female genital mutilation, HC 1091 39