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.
1 https://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.