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The UK’s first FGM prosecution

January 21, 2015

Second guessing the DPP

The extraordinary trial of Dr Dharmasena, the obstetric registrar, who repaired a woman’s vagina after childbirth and now finds himself accused of performing female genital mutilation (FGM), has started (click here).

The case, as presented by the director of public prosecutions (DPP) last year, made so little sense that informed commentators (click here) assumed a political motivation, and that it would either be quietly dropped or that some new detail would emerge to justify prosecution.

Perhaps the prosecutor would bring the victim to the stand to tell the court how she had begged Dr D to leave her labia unsutured, and he had said something like: “No. Your husband wants a wife with adherent labia, so I’m going to re-suture them closed.”  I doubt this is the DPP’s case because we are told the alleged victim has not even made a statement. If it were, it would indeed be terrible medicine, but not FGM; operating without patient consent is assault.

Or perhaps Dr D and the husband had colluded to remove more tissue during the re-suturing. But nothing like that is alleged in the prosecution’s case, at least as summarised in the Guardian (click here).

It appears that, either at her request, her husband’s request, or at her request through her husband, or to stop bleeding, or because he thought that was what everyone else did, or as a result of some combination of these reasons, (Dr D is alleged to have changed his story) Dr D restored the anatomy the patient came in with.  He couldn’t restore it to her birth state, because the labia and clitoris had been thrown away somewhere in Somalia, but the prosecutor seems to think he should have got a bit nearer to that ideal.

I confess I’ve missed the law about restoring anatomy. What would such a law say if the woman had become accustomed to her post FGM anatomy, and asked to stick with what she knew? Perhaps the midwife, Aimma Ali, who is said to have objected to Dr D resuturing the labia at all, will shed some light.

It’s tough being an obstetrician. We not only have to keep parents and family onside – everyone’s an expert in how to deliver babies – and to make every decision with half an eye on the civil courts if a bad outcome ensues, but now we also have to second guess the DPP’s idea of an acceptable anatomical result.

Jim Thornton

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3 Comments leave one →
  1. January 21, 2015 1:40 pm

    Jim, might I be permitted to question a factual point? You say that her clitoris was ‘thrown away somewhere in Somalia’ but do we actually know that? One study reported by the WHO indicates that around 1 in 2 Somalians who’ve been subject to FGM type III were found to have an intact clitoris on defibulation*. Also the medical illustration of FGM type III you’ve previously shared didn’t describe the clitoris being removed prior to stitching. I’m not being facetious or seeking to play down FGM I just think that as a basic respect to the cultures which practice genital cutting we need to acknowledge the range of variation rather than reach for the worst case scenario each time..(?). Only truthful discussion will move this thing forward and if we want Somalians to acknowledge anatomical truths then we must too. *http://www.who.int/reproductivehealth/topics/fgm/defibulation_type_iii/en/

    • January 21, 2015 8:01 pm

      You’re absolutely right Laura. I was carried away by my own rhetoric. Please forgive me. To avoid this exchange making no sense, I won’t correct the post, but your comment will serve to correct the record. Thank you.

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