How to sustain the difficult work to end FGM

Ending FGM is a ferocious challenge, and the work is difficult and complex. I am involved in how we provide care to survivors in the NHS, which we hope will help prevent FGM in the future. But I am also worried that the campaigners and the many professionals I work alongside face professional and personal burdens caused by their involvement. If they do, this will probably affect their ability to carry on - and certainly impact the effectiveness of their work.

The reason I became concerned is that I have seen many colleagues and friends in tears, exhausted and frustrated. I have seen high-profile campaigners, whose voices were so powerful, who have had to step away from the work to protect their own mental wellbeing. These people should have been change-makers for many years to come. If we learn from those involved in ending FGM in other countries, we can be sure that the work in the UK is far from finished.

It was this context which led to my Churchill Fellowship. In Kenya, Egypt, Sierra Leone and Australia, I saw that country-level work to end FGM faced challenges which were very similar. The people involved carried similar burdens and efforts were difficult to sustain. Also there were strategic approaches with a short-term focus, which in the wider and long-term context might actually lead to either no reduction in FGM, or just shift the problem to somewhere else.

One example was in Egypt, where there was a large focus in the 1990s that FGM caused medical consequences such as infections, and this was given as the reason why FGM should be stopped. But the root cause of FGM is gender inequality. Because in Egypt they focused on the consequences of the health complications, those who still supported FGM instead adapted what they were doing, and shifted to having healthcare professionals perform FGM. Many infections may have been avoided over the years by this shift, but the deep-seated gender inequality still manifests in a violent act upon many young girls. So, decades later, campaigners are still fighting, and all those who hoped FGM would end in the 1990s are still involved in trying to end what is known as ‘medicalised’ FGM today. The lesson: tackle FGM as a gender inequality and human rights violation, or the practice may adapt and you’ll have a different fight on your hands.

90% of women in Sierra Leone and Egypt have been cut. Because the scale of the problem was so much greater in scale in these countries than what we see in the UK, the subsequent impacts and consequences also felt as though they were more obvious than here, where an estimated 137,000 women and girls have had FGM. Whilst a significant number, this is still a small percentage of the population. For example, in Sierra Leone, FGM is not illegal and there are groups advocating for FGM either to continue or perhaps to be restricted so that only ‘consenting over-18s’ can choose to have FGM. But the global movement to end FGM recognises that introducing an age limit over which FGM can be ‘allowable’ is a short and slippery slope, leading to coercive control and grooming and no matter what age a woman is, societal pressures will mean she ‘has’ to choose to be cut. Seeing and hearing such pro-FGM arguments discussed openly was a learning opportunity, because debate in the UK is usually so hushed.

As a result of my Fellowship, I would like to see the UK refocus anti-FGM efforts around it being a violent gender-inequality and human rights violation, as I think that much of what we are doing is skirting around the core issue currently. If this were to happen, my other recommendations would naturally follow. These suggest ways to better support professionals and campaigners, and to also make strategic improvements thus reducing the burden caused.

Those working to tackle FGM explained that being isolated was part of why they felt the work was difficult, and that they benefitted hugely from peer support. However, many professional and campaigner network groups are setup but then later peter out, perhaps because the importance of peer support is not recognised or prioritised.

Also, if we really admitted how difficult it is to end FGM, the people combatting it would be given support to carry on. A repeating theme with those I met was how they needed to repeat interactions, and that it took time, much effort, and persistence. This causes enormous fatigue. Some people did change their views relating to FGM almost immediately on learning about it, but many did not. However, many projects in the UK rarely recognise that to change this deep-rooted view might only happen after many conversations, not just one. My conclusion is that because we are not truly understanding how difficult the work is, we are not adequately supporting those involved.

This is a large-scale and strategic shift in thought, which will take time to action. In the short term, I look forward to growing stronger partnerships within the existing projects in the NHS and the UK. We can help each other and look after each other. This will help - but it is not enough. Unless the UK Government and global agencies take a more realistic and strategic approach to ending FGM, I fear the Sustainable Development Goal to end FGM by 2030 will be missed - and millions of women will be cut in 2031 and onwards.