Mandatory reporting of FGM

The commendable editorial Mandatory reporting of female genital mutilation by healthcare professionals¹ drew front-line health professionals’ attention to proposed legal changes² and their clinical implications. We agree with the authors’ concerns regarding confidentiality.³

We wish to draw attention to the distinction between (a) mandatory reporting to the police of any girl or woman aged <18 years found to have undergone FGM, whenever it was performed; (b) the current mandatory submission of FGM statistics by acute trusts (the monthly submission of data by hospitals relating to every case of FGM identified, irrespective of age, to the Department of Health); and (c) the proposed Enhanced Dataset collection. This matters in an environment where doctors risk prosecution for not reporting appropriately.

GPs should be aware that the proposed Enhanced Dataset contains patient-identifiable information. While GMC guidance states that ‘personal information can be disclosed if it is required by law’,⁴ the benefits of mandatory data submission do not automatically outweigh the potential harm to the patient–doctor relationship and public trust. Our concern is that without assurance of confidentiality, FGM survivors may avoid seeking medical help in general practice, even for non-gynaecological conditions. Either a greater case needs to be made that this patient-identifiable data will prevent FGM or changes must be made to maintain confidentiality.

The classification of labial or clitoral piercings as Type 4 FGM for the purposes of the monthly statistics adds further confusion.² This has the potential to undermine the validity and purpose of the data, notwithstanding the fact that many members of the general public and FGM survivors may find it objectionable that such piercings be considered equivalent to the crime of FGM.

Lastly, it was wrong for the authors to impugn the trainee in obstetrics and gynaecology recently exonerated of FGM when suturing after childbirth as ‘claiming to be ignorant of FGM’ as if it were untrue, and without declaring the interest that one author had advised the prosecution. The jury’s rapid decision to acquit after hearing all the evidence must be respected. Interestingly, in public discussion the breach of patient confidentiality at the heart of the story seems to have been lost.

While government involvement in FGM prevention is welcome, greater caution is required. Inadequately-considered interventions alongside intrusive surveillance within the doctor–patient relationship have the potential to cause great harm.

Competing interests

SB was a paid expert for the defence in the 2015 R v Dharmasena trial.