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Obstetric FGM prosecution

February 8, 2015

Whose fault?

Many blame Alison Saunders, the director of public prosecutions (DPP), for last week’s ill-advised prosecution of Dr Dharmasena on the charge of performing female genital mutilation (FGM) during repair of a previously circumcised woman’s vagina after childbirth. I confess I did at first (click here). They accuse her of trumping up a charge to cover her failure to prosecute any primary cases, and contrast the delay in bringing this flimsy case to court, with the 25 minutes the jury took to throw it out.

Dr Katrina Erskine, a consultant OBGYN at Homerton Hospital, with considerable experience in treating victims (here):

“It is ludicrous to conflate anything a doctor or midwife may do at the time of delivery to a woman who has already suffered FGM with FGM itself, and it is insulting to women who have actually suffered FGM. […] It is also a diversion from what we should really be addressing, which is to try and find a way to reduce the incidence not just for girls born in the UK but worldwide.”  The decision to prosecute has ‘left me with no faith in British justice’.

The president of the Royal College of Obstretricians & Gynaecologists (RCOG) writing to members and fellows yesterday (David Richmond’s letter):

“[…] this was the wrong prosecution at the wrong time of the wrong individual. It has generated an enormous degree of anger at the process, sympathy for the patient and concern for the trainee involved. It is difficult to understand how a case that took a year to bring to court was so flimsy that it took the jury less than 30 minutes to dismiss.”

But lawyers aren’t experts in FGM. This particular DPP is a woman, but she’s just a lawyer, advised by medical experts, and campaigners.  It is the latter who over reached. Most have been rather quiet, but one put her head above the parapet, Lib Dem MP, Lynne Featherstone (click here):

‘Whatever the outcome of that case, the shock waves sent through the medical profession when the arrest was announced, hopefully will be very significant in making everyone in the frontline think, what am I doing? Do I know about this?’

In other words, FGM is a terrible crime and we need to publicise it to end it, so let’s prosecute an obstetrician from time to time “pour encourager les autres”.

Imagine what Lynne Featherstone would have said had Alison Saunders declined to prosecute Dr Dharmasena, and a garbled version of events had got into the public domain.  The DPP was damned whatever she did.

Featherstone is typical of a certain sort of campaigner.  FGM is bad, so every possible form of it is bad. Primary infibulation is a crime so re-infibulation should also be a crime.  It’s understandable; no-one wants any woman to be re-infibulated against her will. But it’s hardly the main problem. As we learned last week, at least partial re-infibulation might be needed medically, and if requested by an adult women is not a million miles away from cosmetic vaginal surgery.

Other campaigners have persuaded the World Health Organisation (WHO) to include any genital piercing, or pricking with a needle, within the definition of FGM.  It’s sort of logical, but it’s not common sense. When some Malaysian parent gets prosecuted for doing a tiny needle prick, perhaps to avoid their daughter getting something worse, will we still blame the DPP?

Many campaigners are understandably annoyed when men draw parallels with newborn male circumcision. They can clearly see that although that is wrong, it’s an order of magnitude less wrong and more nuanced than FGM. Why can’t they see that reinfibulation, or pricking with a needle are also wrong, but an order of magnitude less wrong and more nuanced than primary clitoral excision?

This whole trial was a mess, and should never have happened. But don’t blame the lawyers. The doctors, midwives, and paediatricians who advise them, and the campaigners who cheer them on, should look to themselves. FGM is a terrible thing. We should fight the real thing.

Jim Thornton

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One Comment leave one →
  1. February 8, 2015 9:29 am

    I work in a world where FGM is the norm in the villages and uncommon in the middle classes (as an aside the C/S rate for the rich of Addis is 85% as there is no epidural service and the acronym ‘too posh to push’ reach a new apogee). These poor girls are attacked with a razor blade in their homes at the age of about 4 as they are likely to withstand the blood loss then and as the procedure is illegal and a prison sentence may result, they are not taken to hospital, and the scarring is severe. I see them daily as part of my activities as an obstetric fistula surgeon, joyless underage sex, traumatic neglected childbirth, appalling trauma and divorce. A great life in rural Ethiopia. There is of course no easy answer, but if the educated are able to hang on to their genitalia perhaps education might help.

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