Two trailblazing women

To celebrate International Woman’s Day this Friday, 8 March, we’re saluting Hoda Ali and Juliet Albert. Hoda and Juliet work in West London to help those affected by a form of torture that effects over 200 million women and girls worldwide, 137,000 living in England and Wales.*

Female Genital Mutilation (FGM) is the partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons. It is mostly done by people with no medical training and without anaesthetic. It can include cutting or burning the area and can kill children or leave survivors with lifelong pain and physical and psychological damage. Although made illegal here 34 years ago, FGM has persisted in the UK without a single conviction until last month when the mother of a three-year-old girl in London became the first person to be found guilty of the practice. Sentence will be passed at the Old Bailey this Friday (8 March) when she faces up to 14 years in prison.

But will imprisoning parents help and what can be done for survivors and future generations at risk of FGM? I talked to two women on the frontline of FGM in West London; the campaigner Hoda Ali who has pioneered anti-FGM workshops in West London schools, and Juliet Albert, a specialist FGM midwife who set up a ground breaking clinic in Acton which is now the Sunflower Clinic in Du Cane Road.

Although practised widely in Africa, to dismiss FGM as an “African Problem” is too simplistic; there are many countries where FGM is practised and thousands of women and children from these countries have settled here. It also has a historic precedent in West London. In the 1860s a medic called Isaac Baker Brown ran a clinic in Notting Hill surgically removing the clitorises of women who had been diagnosed as having mental health problems including the catchall term “hysteria”.

Hoda Ali and Juliet Albert

Juliet Albert specialist midwife

Juliet set up the first FGM community clinic in the UK in Acton in 2007 before transferring to the Sunflower Clinic in DuCane Road which cares for around 300 pregnant women and 90 non pregnant women each year. Juliet works two days a week with another midwife, two health advocates and a counsellor who helps women come to terms with their experience.

“Some of the women we see are terribly, terribly traumatised. They cry from the moment they walk through the door until the moment they leave. “Not every woman with FGM has pain, but the ones we see can have complex perineal trauma, and fistulas, and are in pain every day of their lives… Some of the women have come to the U.K. at a young age and are just as English as the rest of us.”

Juliet recalls an 18 year old Eritrean woman who had come to the UK when she was just three years old and only discovered she had FGM when she visited her GP at the age of 18.

“She came to me in Acton and said “I got an A+ in biology but never knew I was supposed to have two holes.” She had a very small 2cm diameter hole, so it took her 10 minutes to pass urine and she had blood clots during her period, yet she had no idea she was different.”

One 19 year old woman from Somalia came in with type 3, and had been cut at the age of six.

“The woman said she had come to this country when she was 10 years old with a cyst the size of a satsuma attached to her genitals. She couldn’t go swimming, do gymnastics, and get undressed with the other girls in her school. She felt very ashamed and scared and had never spoken to anyone about it. She came to the clinic and had it removed. She was opened and it changed her life. I saw her a couple of years later and she was pregnant and everything was fine. Some women are in real pain for the rest of their lives but for some women with type 3, there is help we can give them.”

“It’s such a privilege to work with women where you can make such a profound change to their lives.”

Has changing the law helped?

The earliest law that was put in place to tackle FGM in the UK was the Prohibition of Female Circumcision Act 1985, which was replaced by the Female Genital Mutilation Act 2003.

Although making FGM illegal in this country proved a deterrent, it drove the practice elsewhere. Juliet knew of women who were against FGM, but whose relatives would take their children to be cut when they visited them in the holidays. So in 2015 a new law was put in place including the crime of failure to protect, so parents are responsible, even if they didn’t arrange to have it done themselves.

“I think the police are responding in a sympathetic way, which is good. We don’t want to take parents to court and away from their children unless there’s a really good reason to do so… Thankfully, most cases we see are historic and most families living in this country say they are relieved that they don’t have to practise FGM.”

In 2015 mandatory reporting was introduced, has that helped?

Juliet explains “Part of me thinks that mandatory reporting is a good idea, however. I’m not sure whether making a healthcare professional ring the police is really benefiting anybody, because it makes families and women really scared to access health services.”

“Although it’s called child abuse, that usually means long term harm, whereas with FGM it’s unusual for parents to want to harm their children, it has to do with conforming to social norms.

“On the positive side, there is more training and survivor campaigners have made a huge impact as people were worried about getting involved with something so culturally sensitive. Ten years ago, if I referred a patient to social services they would ring me saying “I don’t know what to do.” Whereas now we have specialist social workers and health advocates so we’ve made huge progress. “Maternity services have been leading the way with FGM in a lot of respects but gynaecology services, A&E departments and Sexual Health clinics need to catch up.”

What can be done?

Hoda Ali, is a nurse and anti-FGM campaigner

“Education is the key. That’s why I became a campaigner. I wouldn’t have done so as a survivor of FGM, but when I was working as an NHS nurse for ten years, I recognised there was so much ignorance, that even health professionals in the 21st century in the Western world did not understand the problem, none of them knew.”

In March last year Hoda was nominated as an Amnesty International Human Rights Defender, and appears on the Suffragette Spirit Map.

She currently leads a pioneering project to end FGM with Ealing council and Perivale primary school. It involves children, parents and staff and was showcased in parliament*. Despite this, no government funding has been forthcoming, but the John Lyons charity is paying for a three year project in 15 schools, including Southfields, on the Chiswick border.

‘I’m from Somalia and I was cut when I was 7-years-old. I nearly died and have had severe medical problems as a result and can’t have my own children. If you have gone through FGM, it never leaves you, it’s with you for the rest of your life.”

So why do families do this?

Complex, deeply rooted cultural pressures force families into practising FGM and there are many myths that have grown to justify the practice. In some cases families may be ostracised and told that their girls aren’t clean and won’t get married if they are not cut.

Hoda explains “In some cultures, if you don’t do this to your child, you and they will never be accepted by society. If I had not been cut at seven I would have been bullied at school, I would not have had friends as my friends’ mum and dad would have pulled them away from me saying I was a dirty child. My father was educated and did not want us cut, but my mum, who had been cut, like her mother and grandmother before her, organised it when he travelled. I understand why my mum did it to help us fit into society. She did not know any better.”

How to break the cycle

“We can break the cycle as long as you speak up and you know right from wrong. I have saved my nieces.

“They were born here and will never, ever, ever, ever go through FGM, which means so much to me because of what I went through, especially because of my medical problems. Yes, my nieces were the first ones to be saved. “

Hoda’s nieces featured alongside her in the first anti FGM billboard in the UK which won the CLIO Award for Advertiser of the Year in 2015.

Making change in west London

Hoda is working with primary schools in Ealing, and last week was at Southfields which borders Chiswick. It’s a year long educational programme aimed not only at the school staff and children but also parents who attend six workshops on safeguarding in general, then building up to FGM awareness.

“It’s particularly important in a primary school, as if any child is going to have FGM its going to be before she goes to Secondary School.”

“We recognised we needed to speak to the parents; we can’t do anything without them.”

“But you can’t say “I’m coming to talk to you about FGM”. So I work with schools for the whole year doing 6 workshops about safeguarding in general and at the end the parents get a certificate.”

” We are educating and empowering!”

Find out more about Hoda’s work @HodoMAli ‏

And Juliet’s here: The Sunflower Clinic

Hoda refers survivors who need psychological help to The Dahlia Project a specialist service for women who have undergone Female Genital Mutilation. It is run by Leyla Hussein and is the only clinic that provides therapy in the whole of the European Union.

There are three main types of FGM:

Type 1 (clitoridectomy) – removing part or all of the clitoris. In some countries there can be reconstructive surgery for this, but it is not allowed in the UK as medical research around this has not been robust and some women have been left with disastrous results.

Type 2 (excision) – removing part or all of the clitoris and the inner labia (lips that surround the vagina), with or without removal of the labia majora (larger outer lips).

Type 3 (infibulation) – narrowing of the vaginal opening by creating a seal, formed by cutting and repositioning the labia. The Sunflower Clinic can help women with type 3 with a surgical procedure to enlarge the vaginal opening.

* The United Nations classes FGM as a form of torture

*Data from UNICEF report Feb 2018