Chapter 8
Responding to FGM/C in the UK African Diaspora: Prioritising Criminalisation Over Care
Magda Mogilnicka, Natasha Carver, Saffron Karlsen, Christina Pantazis, and Hannelore Van Bavel
Introduction
The United Nations (UN) is committed to ending ‘FGM’
1The authors are using inverted commas to indicate the problematic coloniality of power in the term ‘female genital mutilation’ (Carver et al. 2024). The term FGM will be used, without inverted commas, when referring to proper names such as FGM Protection Orders or FGM safeguarding. by 2030, as part of its global efforts to achieve gender equality. This has led to significant legislative developments enacted across the world (Kandala and Komba 2018), reflecting international concerns about the extent and scale of FGM/C, the globalisation of human rights discourse, and the mainstreaming of a gender violence framework (Van Bavel
et al. 2024). In line with this powerful international prohibitionist agenda and galvanised by problematic assumptions about the prevalence of the practice in the UK, successive UK governments have enacted a body of legislative provisions to ‘send the message’ that ‘FGM’ is not tolerated in the UK (Carver
et al. 2024). Despite this, prosecutions for ‘FGM’-related offences can be counted on one hand, a lack which has been repeatedly interpreted as evidence that this is an epidemic of ‘hidden crime’, which requires tighter legislation and harsher penalties (ibid.). Hence since 2015, a conviction for ‘FGM’-related offences can result in up to fourteen years’ imprisonment, while the introduction of FGM Protection Orders (FGMPOs)
2Protection Orders are issued by UK family courts to protect children from domestic abuse. means that significant court action can occur simply based on a suspicion that ‘FGM’ might take place in the future.
In the UK, political and media discourse on ‘FGM’ has typically been couched in nationalistic and nativist terms, often emphasising the need to save British girls from the barbaric practices of their racialised and othered migrant parents (Carver et al. 2022, 2024). Such discourse (re)produces a racist logic that constructs African diaspora cultures as fixed and determinative, and ‘FGM’ itself as an atavistic and inherently patriarchal practice incompatible with the claimed liberal values of the West (Gruenbaum et al. 2023; Njambi 2004).
In this chapter, we draw on three of our research studies which address the development, implementation, and impacts of UK ‘FGM’ law and policy on African diaspora and other affected populations. Two qualitative studies, conducted in Bristol (south-west England) in partnership with local communities and grassroots organisations, explored the experiences of those from affected groups both in relation to FGM safeguarding and in seeking support for FGM/C-related health issues. We also undertook a review of FGM/C prevalence data collected via freedom of information requests, which have been used by successive UK governments to inform the development of law and policy. Our findings suggest that policy has been developed on the basis of unreliable data, which exaggerate the current risks to girls and women living in the UK. Moreover, despite intentions to reduce harm through eliminating ‘FGM’, current policy approaches have simultaneously inadvertently led to the unfair criminalisation and stigmatisation of African diasporas living in the UK and encouraged the neglect of the healthcare needs of those already living with the consequences of FGM/C (Pantazis et al. 2025).
The chapter proceeds in five substantive sections. First, we set out the UK legislative and policy framework, followed by a discussion of prevalence data and the difficulties of estimating the prevalence of FGM/C. We then present details of our Bristol case study, before discussing findings from our two qualitative studies which provide evidence of stigmatisation and criminalisation on the one hand, and a neglect of health needs on the other.
Legislative and policy responses to ‘FGM’ in the UK
‘FGM’ was explicitly prohibited in the UK through the Prohibition of Female Circumcision Act 1985. A racial logic embedded in the Act created a legal distinction between ‘FGM’ and other female genital surgery, whereby girls and women of colour or with migrant heritage were understood as helpless victims of their patriarchal culture while white European/Western girls and women seeking similar surgery were perceived to have legitimate concerns about genital variation and the agency to make decisions to conform to a supposedly non-cultural norm (Carver et al. 2024; Iribarne and Seuffert 2018; Shahvisi and Earp 2019). As such, the same surgeries became considered to be ‘mutilation’ on some bodies, but ‘beautification’ on others (Carver et al. 2024; Earp 2022; Fusaschi 2023). The 1985 Act was superseded by the Female Genital Mutilation Act 2003, which kept the same binary double standard while symbolically changing the name of the offence and making it extra-territorial so that those taking girls or women abroad for the procedure could also be charged with an offence (Carver et al. 2024). Both Acts, however, were primarily symbolic and had no discernible impact on arrests or prosecutions (ibid.).
Political concerns relating to this prosecutorial inactivity resulted in further policy and legislative action through the Serious Crime Act 2015, which (amending the 2003 Act) made all those ‘habitually resident’ in the UK protected by the law regardless of their visa status. The 2015 Act also introduced mandatory reporting of ‘FGM’ for a range of professionals with responsibility for safeguarding, as well as new recourse to civil remedies through FGM Protection Orders. FGMPOs are issued by family courts and involve an assessment of future risk in which the standard of proof is the balance of probabilities rather than determining beyond reasonable doubt that criminal activity has taken place. Consequently, FGMPOs may be applied even in situations of relatively low risk (Pantazis et al. 2025).
To date, there have been three convictions in the UK for ‘FGM’-related crimes. In the first, which took place in 2019, a mother without cultural heritage relating to female circumcision was found guilty of cutting her child alongside other child abuse. In the second, in 2023, a woman was convicted of assisting the occurrence of ‘FGM’, having accompanied a child abroad in 2006, when she herself was a young adult. In 2024, a man was convicted of arranging and paying for a girl to go abroad for ‘FGM’. The small number and nature of these convictions adds further weight to indications that the prevalence of ‘FGM’ in the UK is not what the policy assumes.
Guestimating prevalence
Current government estimates suggest that around 60,000 ‘British’ girls living in the UK are at risk of experiencing FGM/C (Office for Health Improvement and Disparities 2014). These estimates are not calculated in relation to any evidence of FGM/C prevalence gathered in the UK, nor do they include girls at risk of undergoing cosmetic genital surgery. Instead, FGM/C prevalence figures collected by UNICEF in high-prevalence countries from which African diasporas migrate to the UK are applied to population figures and birth rates for the UK-resident population. This assumes that these prevalence rates are not only reliable – both in relation to the country of their source and in the UK context – but also static.
There is now a large and growing body of evidence to support claims that these assumptions are problematic. Internationally, existing research highlights concerns with the reliability of these estimates, even in settings in which the data were collected (Elmusharaf et al. 2006). There are also several problems with applying these data to UK contexts. Firstly, it is likely that FGM/C is less common amongst migrants than those remaining in high-prevalence settings, particularly given that claims for asylum are routinely made on the basis of avoiding FGM/C (Kea and Roberts-Holmes 2013; Middelburg and Balta 2016). There is also evidence that attitudes to FGM/C change following migration (Ali et al. 2020; Carver 2021; Cohen et al. 2018; O’Brien et al. 2016). Understood as a strategy for social mobility in communities in which it is practised, its value can be lost on migration to non-practising societies. In the UK this tendency has been encouraged by effective educational initiatives organised by affected communities themselves (Ahmed et al. 2022; FORWARD 2017; Small et al. 2020).
Our research adds to this evidence and suggests that the data underpinning ‘FGM’ policy in the UK are not only extremely limited but also unfit for purpose. The data suggest that the actual prevalence of FGM/C in the UK is much lower than is presumed in government estimates. Clinical studies of National Health Service (NHS) populations reveal a small number of cases (Ali et al. 2020; Creighton et al. 2016; Hodes et al. 2016). For example, Hodes et al.’s (2021) review of data from the British Paediatric Surveillance Unit (from over 90 per cent of consultant paediatricians between 2015 and 2017) identified just 103 FGM/C cases, which included genital piercing. In comparison, some 266 labial reduction operations were performed on girls under the age of fourteen on the NHS between 2008 and 2012 (British Society for Paediatric & Adolescent Gynaecology 2013:4). There has also been a significant global increase in cosmetic genital surgeries since that time (Liao and Creighton 2019:2).
Evidence of institutional responses to FGM/C since the 2015 Act, gathered from freedom of information requests to the Home Office, Department for Education, and Ministry of Justice, also suggests that these estimates exaggerate the scale of the issue in the UK (Karlsen
et al. 2023). Additionally, analysis of publicly available data from the NHS’s FGM Enhanced Dataset,
3The FGM Enhanced Dataset was set up by the Department of Health in 2015 to monitor the level of FGM/C in the UK. This requires general practitioners (GPs) and mental health and acute trusts to gather details about FGM/C among their patient populations. the Home Office’s official statistics, and the Crown Prosecution Service’s official reports supports this claim. While this is likely to be an under-estimate, only seventy-four FGM/C offences were reported to the police (excluding Manchester Metropolitan Police) in 2019–20 (Karlsen
et al. 2023). The Ministry of Justice recorded almost 600 FGMPOs between 2015 and 2020, but none was reported as ‘breached’ (e.g. having led to an experience of FGM/C) by 2019 (Karlsen
et al. 2023). While the FGM Enhanced Dataset only collects data from clinic populations and is, again, incomplete,
4Only 2.5 per cent of GP practices and 62.7 per cent of NHS trusts had ever submitted information to the dataset by 2020 (Karlsen et al. 2023). our investigation into available data suggests that as few as eight girls and young women aged under eighteen and living in the UK have experienced any type of FGM/C between 2015 (when the record began) and 2020 (Karlsen
et al. 2023). It is also worth noting that political and media discourses regarding ‘FGM’ often encourage assumptions that the majority of FGM/C risk experienced in the UK relates to its most extreme form, notably infibulation (WHO Type 3) (Ali
et al. 2023). Data from the FGM Enhanced Dataset suggest that the number of girls and women aged under eighteen experiencing these FGM/C types in the UK between 2015 and 2022 may be as few as one or two (Karlsen
et al. 2023).
While far from comprehensive, the picture of UK FGM/C prevalence presented by this data would suggest that the policy responses described above are heavy-handed, as the scale of FGM/C seems much smaller than official estimates. The over-zealous policy approach was also a concern raised by our community partners, to whose perspectives we now turn.
The Bristol context
Our case studies were conducted in Bristol, a city in south-west England. With its large population of African diasporas,
5https://www.bristol.gov.uk/council/statistics-census-information/census-2021 [Accessed 2 September 2025]. Bristol has a long tradition of anti-‘FGM’ campaigning that is rooted in the work of activists from affected communities (Carver 2021; FORWARD 2017; Lewicki and O’Toole 2017). As indicated above, this long-term work had a significant impact on changing attitudes towards FGM/C among local affected groups (Ahmed
et al. 2022; Small
et al. 2020). However, it was a campaign emanating through a Bristol-based charity for young people, Integrate,
6This charity has since become national and is now called Integrate UK: https://integrateuk.org/ [Accessed 2 September 2025]. that brought public attention to the supposed extensive scale of the practice and lack of criminal convictions for FGM/C in Bristol and nationally. As well as significantly contributing to national policy and legislation, this dual-generational activism led to a series of local initiatives that became known as the Bristol Model, which included guidelines to support risk assessment for professionals (Bristol Safeguarding Children Board 2018). The Bristol Model was initially praised as an example of a successful multi-agency collaboration and an exemplar for organisations elsewhere in the UK (Carver
et al. 2023).
Despite this positive collaboration, concerns about local and national policy started to create tensions, which were exacerbated by a series of events in 2018. The first was the attempted prosecution of a Bristol Somali father for allegedly organising FGM/C for his daughter. The case was dismissed mid-trial by a judge who found the prosecution’s sparse and faulty evidence ‘deeply troubling’.
7BBC News (2018). No byline. ‘Bristol FGM case against father dropped’. 22 February. https://www.bbc.co.uk/news/uk-england-bristol-43153529 [Accessed 11 July 2025]. It triggered an outburst of anger from groups who had experienced FGM safeguarding, aimed at local authorities, police, politicians, and anti-‘FGM’ activists. Tensions were compounded by the release of a Channel 4 documentary a week later called
The FGM Detectives, focused on the police as they investigated the case. In response, some local parents organised themselves into a campaign group called Somali Parents Against Stigmatisation to draw attention to the harm, stigmatisation, and racial profiling created by the FGM-safeguarding policy and practices. This led to several community-led actions including the production of a touring theatrical show dramatising people’s experiences, and an approach to the University of Bristol with a request for academic research on the impact of FGM safeguarding.
In partnership with Somali Parents Against Stigmatisation and other local organisations, we recruited thirty individuals into six focus groups in 2018. The focus groups involved Somali-heritage participants, including some anti-‘FGM’ community activists and individuals from community engagement organisations; therefore they did not rely only on the perspectives of those linked to the Somali Parents Against Stigmatisation group. Separate focus groups were conducted with men, women, and young people. As well as developing the study aims with our collaborators, preliminary findings were also presented to participants and partners for validation before the official launch, giving them an opportunity for feedback and further input.
Furthermore, in 2022 the research team worked with Caafi Health,
8https://www.caafihealth.org.uk/ [Accessed 2 September 2025]. a local grassroots health organisation supporting ethnically minoritised communities, to specifically consider the healthcare needs of women and their families and whether and how they were recognised and responded to within statutory healthcare settings. Caafi Health led the recruitment of participants and facilitation of seven focus groups and fourteen qualitative interviews with men and women from ten different national backgrounds from affected communities (see Pantazis
et al. 2023).
Understood as a research process in which ‘the contribution of stakeholders’ knowledge is vital to create knowledge’ (Turnhout et al. 2020:16), an ethical commitment to knowledge co-production has been a fundamental part of our work on FGM/C. Our research has been driven by a feminist approach that recognises the intersectional marginalisation of racially and ethnically minoritised communities (Crenshaw 1991). As white researchers, guided by ethical principles, we have tried to be sensitive to polarising FGM/C debates, even within affected communities. Mindful of the importance of giving voice to marginalised communities, we nonetheless had to navigate complicated power hierarchies which are often inherent in a research process (Alcalde 2007).
UK FGM-safeguarding policy as stigmatisation, (re)traumatisation and ‘unbelonging’
Our research found that current approaches to FGM-safeguarding were stigmatising and (re)traumatising
9This is to acknowledge both experiences: retraumatisation for women living with the consequences of FGM/C, and traumatisation for women/girls who have not experienced or known about FGM/C before safeguarding encounters. individuals, families, and entire communities (Karlsen
et al. 2019), experiences which, for many, led to self-policing practices and directly undermined a sense of belonging in British society (Carver
et al. 2022).
The introduction of mandatory reporting has made professionals in education, social services, and healthcare responsible for FGM safeguarding, and to an extent they have become accountable for its ‘success’ or ‘failure’ (measured in relation to prosecutions, which ignore the problems embedded in these assumptions). At the same time, an intensive publicity campaign in media and political debates around ‘FGM’ drew attention to its assumed high prevalence, framing identified cases as ‘just the tip of the iceberg’.
10Tran (2015). Mark Tran. ‘Female genital mutilation increase in England “only tip of iceberg”’. The Guardian Online, 30 April. https://www.theguardian.com/society/2015/apr/30/female-genital-mutilation-england-fgm-girls [Accessed 11 July 2025]. The then Education Secretary, Michael Gove, wrote letters to schools, warning against the risks of ‘FGM’ and encouraging referrals.
11Burns (2014). Judith Burns. ‘Watch for student radicalisation, Michael Gove tells schools’. BBC Online, 8 May. https://www.bbc.co.uk/news/education-27334799 [Accessed 11 July 2025].Despite risk-assessment guidelines set in place by the Bristol Safeguarding Children Board
12Local Safeguarding Children Boards were responsible for coordinating local efforts to protect and promote the welfare of children in the UK. In 2018 they were replaced by Local Safeguarding Partners. through the Bristol Model, it appears that risk assessments are frequently used incorrectly. In schools, for example, an expectation that teachers would meet with families planning to take their children out of school during term time to establish a likely risk of FGM/C can instead lead to an immediate request for safeguarding interventions by the police and social workers (Karlsen
et al. 2019). As our freedom of information requests to the Department of Education demonstrate, there were 1,910 school referrals made between 2016 and 2018 (Karlsen
et al. 2023). While the reasons for this approach remain unclear, it is likely encouraged by the problematic political narrative regarding the high numbers of girls at risk described above, and the associated warnings by the police, reinforced in the media and by politicians, about exercising due diligence in the lead-up to the supposed ‘cutting season’.
13Particularly in light of UNICEF figures from 2020 that state the prevalence rate for FGM/C in Somalia is 99 per cent (Karlsen et al. 2023). Also see Ritchie (2016). Meabh Ritchie. ‘This is what it’s like to pee after female genital mutilation’. BBC News Magazine, 24 April. https://www.bbc.co.uk/news/magazine-36101342 [Accessed 11 July 2025]. Rather than providing nuanced attention to the circumstances of each family, mandatory reporting has encouraged a fixation with identifying and responding to the perceived hidden epidemic of offences with approaches which treat
all parents as potential offenders:
The meeting we had with the headteacher was like, ‘the reason we’re covering FGM is because it is done by your community’. When I said, ‘but there are other communities that do it’, he said, ‘it’s mainly Somali communities we’re targeting’. He said, ‘In Bristol, the main communities that do it, it’s them …’. (Mother, FGM-safeguarding study.)
Home visits, following referrals, were reported as the most intimidating aspect of FGM safeguarding:
[The visit was] a horrific, horrific experience. [You] open the door and you see a policeman, [you’re] going to be shocked. I’d never been in contact with police. For the first time to be in contact with the police just by default, just based on where I’m from basically, I think it’s even worse than the stop and search policies. This is targeted at Somalis deliberately. (Woman, FGM-safeguarding study.)
Unsurprisingly, this situation has created considerable concern and a sense of stigmatisation and criminalisation amongst people in affected communities:
A lot of families have said that they feel that they’ve done something wrong when really and truly they haven’t done anything wrong. They feel that they’ve committed a crime. They feel that they’ve been targeted, stigmatised, racially profiled. (Young woman, FGM-safeguarding study.)
The heavy-handed approach has led to stigmatisation and been driven by assumptions repeated in the media on high prevalence and hidden ‘FGM’ crime.
Such misinterpretations of FGM/C prevalence and FGM-safeguarding guidance could also lead to insensitive and upsetting experiences in healthcare settings. This is despite the clear acknowledgment – explicitly evidenced here – that women who have experienced FGM/C are victims of abuse:
[The midwife said] ‘We’re just going to talk about FGM’. She said, ‘in Bristol, it’s highly practised. Because it’s highly practised, we need to make sure, because you were abused, we need to make sure that you don’t abuse your child.’ Abuse? That was due to ignorance, that was thirty-three years ago, nothing that happens now. (Woman, FGM-safeguarding study.)
Yet while such misreading of the guidance can produce problems, negative experiences in healthcare might also be considered inevitable given the new legislative obligation placed on health professionals to ask women about their experiences of FGM/C, without any attention to or training regarding the sensitivity needed to discuss such traumatic events. As such, it is not surprising that FGM safeguarding in healthcare settings appeared to bring a particular risk of retraumatisation:
The parents who had it done they are traumatised … To ask mothers who are traumatised [about that experience] over and over and over again. You’re putting salt on that wound, you’re making it fresh again. They didn’t have a choice when they were young. (Woman, FGM-safeguarding study.)
The negative impact of FGM safeguarding, in schools, healthcare settings, or elsewhere, did not only affect those who directly encountered FGM safeguarding but also spread fear throughout the wider community. This concern encouraged an internalised hypervigilance which led to a self-policing of families’ conduct. Families were changing their behaviour to protect themselves and their daughters from potential intrusive police investigations and medical check-ups:
If you come back from holiday, you have to tell your daughters, if they go in the toilet for longer than ten minutes … some girls, they love to go to toilet, just for a chit chat. But then the teacher [feels she] needs to keep an eye out. If she sees a Somali girl walking out the room, she needs to put a time on her [to see how long she goes out for], which is again stigmatising, because a British girl, she might not [feel the need to] check the time. If they are staying more than ten minutes, [the teacher will] report her. So [Somali people need to] just let your girls know, wee and go back to the classroom. (Woman, FGM-safeguarding study).
Focus group participants explained that a threat of medical examination after holidays was one frequently made during police and social workers’ home visits (Karlsen et al. 2019:42–3), following referrals. It was unclear how often they actually occurred and therefore unclear what role these played in this process (i.e. whether they were simply designed to instil fear). Fear associated with the nature and consequences of safeguarding, particularly a home visit from the police and social services, led some families to decide against foreign travel. This was recognised as a significant loss of freedom which was linked to the discrimination inherent in the policies:
Parents [are] choosing to stay because they fear being targeted. No civil liberty. You cannot exercise your right to travel. (Man, FGM-safeguarding study.)
It shouldn’t be like that, you know, because as [with] everybody else in this country, when you are travelling, you should be able to travel without problems. (Man, FGM-safeguarding study.)
The hypervigilant approach to FGM safeguarding has altered the behaviour of African diaspora families who started policing themselves to avoid encounters with the police and social services. The ways in which FGM safeguarding was driven by a problematic racialised logic was described very clearly in our focus groups: ‘I thought safeguarding was when you think that child is in danger. But for us it was just because we were Somali’ (Woman, FGM-safeguarding study). This was encouraged by explicit experiences of racism in encounters with safeguarding officials:
I speak good English and they felt they could belittle me and undermine me further by saying, [in a patronising tone] ‘Do you understand what we’re saying?’ You know very, very bad practice, humiliating and micro-aggression of racism and discrimination they were presenting and that left me really, really upset. (Mother, FGM-safeguarding study.)
In the focus groups, parents went to considerable lengths to explain why this treatment was unjustified, emphasising their everyday efforts to be ‘good parents’ and maintain society’s expectations of them to uphold standards of good and law-abiding citizens (Carver et al. 2022). The targeting of Somali-heritage families through FGM-safeguarding procedures, despite their ‘responsible’ conduct, could make people feel excluded from the British nation due to their racial and ethnic background:
Definitely my [British] identity was questioned. I didn’t feel like a British citizen … I’ve got a British passport, but I’m not. You are treated differently. I felt like I didn’t belong here. All this time I’ve wasted thinking I fitted in – you question yourself, ‘do I really fit in?’ (Woman, FGM-safeguarding study.)
Participants experienced FGM-safeguarding encounters as ‘an act of unbelonging’ (Carver et al. 2022:4561) as they reflected on what they believed were inherently discriminatory policies. The criminalising measures made them feel like ‘not good enough citizens’, denying them the rights and privileges of British citizenship, despite their efforts to fit in.
The impact of UK FGM policy on engagement with and provision of healthcare
This study also revealed how safeguarding encounters have undermined participants’ sense of trust in and use of healthcare services. Our conversations raised concerns that the policy attention given to criminal responses to the issue, and pre-emptive policing, not only risked people’s health through the stigmatisation, criminalisation, and retraumatisation but also undermined the provision of support to address the needs of women and their families living with the long-term consequences of FGM/C, exposing a wider issue of healthcare negligence.
Between April 2015 (when records began) and June 2024, around 38,600 women and girls were identified as having experienced some form of FGM/C and registered on the NHS FGM Enhanced Dataset.
14https://digital.nhs.uk/data-and-information/publications/statistical/female-genital-mutilation/april---june-2024 [Accessed 11 July 2025]. Because this only includes those engaging with the NHS, and they are mostly identified through maternity services, this is likely to be an underestimate. Given that this includes people with experience of a range of FGM/C types, the long-term consequences of these experiences will be heterogeneous. Anti-‘FGM’ policy is largely premised on the short- and long-term consequences of ‘FGM’ for women’s physical, psychological, and sexual health (WHO 2016). FGM/C can also have consequences for male partners, who can experience a range of physical and psychological consequences affecting sexual functioning (Almroth
et al. 2001). Yet, despite WHO global guidelines (WHO 2016), and the UK’s Department of Health (2015) commissioning support services for the provision of better healthcare for people living with the consequences of FGM/C, our research suggests that efforts to address these needs have not been prioritised, as a consequence of the policy focus on pre-emptive safeguarding.
Contributors to both our studies described a persistent lack of engagement with statutory healthcare services. This was in part caused by the ‘offensive’, violating’, and ‘embarrassing’ nature of FGM-safeguarding approaches, which were considered to prioritise getting data for the FGM Enhanced Dataset over the actual healthcare needs of patients:
This comes from just going to the GP when you’re not feeling well and they bring FGM into the conversation out of nowhere. (Man, Care Poverty study.)
When I go to the GP, they ask me again and again, did you do that [FGM]? I told the GP, please write down on your computer, I don’t want to do that [FGM] and so please don’t ask me any more questions. I hate to hear these kinds of questions. (Woman, FGM-safeguarding study.)
The relentless nature of FGM safeguarding in healthcare settings undermined people’s trust in statutory healthcare services. Some recalled healthcare encounters in which interrogations about FGM/C were prioritised over diagnoses:
Instead of the nurse trying to figure out why I was in such pain or what – you know, the usual procedures, bloods, blood pressure, all of that – she [the A&E nurse] skipped all those steps and directly, she was like to my mum, ‘Have you done FGM to your daughter?’ (Young woman, FGM-safeguarding study.)
Healthcare encounters are not only described as stressful as they (re)traumatise patients by persistent questioning about FGM/C, but they can also potentially contribute to health risks if medical professionals fixate on FGM/C instead of focusing on the treatment of urgent health issues. Our studies suggest that African diasporas can experience an unethical approach in healthcare settings, from the remarks made by research informants about a lack of care shown by medical practitioners:
[The health visitor] is asking all the time. […] Before they cared about your health and how the child was feeling. Now it’s just FGM. (Woman, FGM-safeguarding study.)
Given negative FGM-safeguarding encounters, lack of trust was emphasised strongly as one of the barriers for accessing healthcare settings. The fear of being interrogated by GPs, nurses, or midwives creates a sense of hopelessness and worries about the well-being of participants’ daughters:
We are just very worried now. I’ve got a daughter who is nearly twelve, if anything should happen to her, to her privates, if she gets an infection, the first thing that comes in my mind is this situation [FGM safeguarding]. … It’s very stressful, it keeps coming back. The first thing that comes in my mind is that the doctor will ask you this question. (Woman, FGM-safeguarding study.)
Concerns raised by many participants around medical professionals’ intentions to focus on FGM/C instead of actual health problems were a reason for some to avoid statutory healthcare and rely on alternative medical treatments, potentially risky to their health (Karlsen et al. 2019). Moreover, a judgmental attitude expressed by midwives during pregnancy care, highlighted by some participants, encouraged a sense of being responsible for their experiences of FGM/C. This resonates with our earlier discussion of the ways in which the racist logic of current policy considers all people from affected groups as implicated in these ‘cultural crimes’: ‘I’m being blamed for something that was done to me’ (Woman, Care Poverty study). Such experiences lead to feelings of guilt and mistrust that cause a general reluctance to engage with healthcare and specifically to discuss health concerns related to FGM/C.
Many participants described healthcare (and other safeguarding practitioners’) approaches as lacking both cultural sensitivity and staff from affected communities, which further hinders healthcare service engagement: ‘You cannot train someone in someone else’s culture, they wouldn’t understand. They have never been there [to Africa]’ (Woman, Care Poverty study). Hence, there was a recognition that all FGM-safeguarding practitioners need to ‘be sensitive to that person’s culture, no matter what that culture is. You need to be aware [of ethnic differences]’ (Young woman, FGM-safeguarding study). Hence, a fear of judgment, combined with harsh FGM-safeguarding measures and a lack of diversity and cultural understanding, contributed to a sense of statutory services being biased and encouraged people to withdraw from using them.
Discussion and conclusion
This chapter discussed recent UK government responses to ‘FGM’ and their impacts on the experiences of African diaspora communities living in the UK. We argue that, based on a methodological approach which exaggerates the risk of FGM/C to British-born girls while actively ignoring the risks and uptake of female genital cosmetic surgeries, the UK government’s priority has worked to prevent future occurrences of FGM/C through criminalisation, with a number of significant negative consequences for all those with heritage in FGM/C-affected groups. Official estimates of 60,000 girls at risk of ‘FGM’ are based on inaccurate evidence that extrapolates statistics from high-prevalence countries and applies them to the UK without considering socio-cultural changes and shifts in attitudes. An assumption about ‘hidden crime’ has led to legislation and policies that prioritise pre-emptive responses that have stigmatised African diasporas, leaving them feeling excluded and targeted. As demonstrated in this chapter, stigmatisation reported by studies’ participants has been experienced by the wider diaspora as a result of over-zealous approaches to FGM safeguarding. Drawing on evidence from our research conducted in partnership with affected groups, we considered the consequences of the poverty of accurate and reliable data in the UK context and the ways in which this encourages the development and use of discriminatory law and FGM-safeguarding policy. The hypervigilance of FGM safeguarding, in contrast to a less vigilant approach in tackling other cases defined as child abuse, constructs the diaspora as a ‘suspect community’ (Pantazis and Pemberton 2009) based on ethnic and religious characteristics. This reflects wider political racialisation of Black and Muslim identities as culturally incompatible with British values. Hence, in this area, the legislation and policy should be conceptualised as institutionalising racism (Pantazis et al. 2025) by requiring public service professionals to operate from a starting point that assumes African communities to be backward and deviant. The policies and practices (re)traumatised the community, questioned people’s feeling of belonging to the UK, and created a strong sense of mistrust of health, education, and social services.
The health and well-being needs of the large number of adult women living in the UK with the long-term consequences of FGM/C are consistently overlooked, with significant repercussions for them and their families. Neglecting the healthcare responsibility for citizens who have experienced FGM/C may lead to long-term unaddressed consequences that impact the health of people living with FGM/C consequences. This shows an embedded racialisation process in policies that consider Muslim people of colour as the threatening ‘other’ and treats their needs as secondary. The legislative approach is grounded in powerful global discourses that construct FGM/C as a barbaric practice brought by African diasporas, incompatible with Western values. Dominant ideas about Muslim Black female bodies that have experienced FGM/C as deviant, abnormal, and dysfunctional continue their intersectional marginalisation.