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The reality of FGM in the UK
  1. Pollyanna Cohen1,
  2. Martina Larsson1,
  3. Gayle Hann2,
  4. Sarah Creighton3,
  5. Deborah Hodes3
  1. 1 Department of Paediatrics, University College London Medical School, London, UK
  2. 2 Department of Paediatrics, North Middlesex University Hospital, London, UK
  3. 3 Department of Paediatric and Adolescent Gynaecology, University College Hospital, London, UK
  1. Correspondence to Ms Pollyanna Cohen, Department of Paediatrics, University College London Medical School, London WC1E 6BT, UK; zchaprs{at}

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Weston’s review of the law1 in relation to understanding the legal nuances in female genital mutilation (FGM) is important in the fight to end the practice. Yet in order to effect real change an understanding of practising populations’ attitudes and beliefs is needed. There have been a few studies in the UK asking professionals about their knowledge but little about the communities themselves.

The commonly used questions from Unicef and the United States Agency for International Development (USAID) household surveys, which have been undertaken in 29 African and Middle Eastern countries from 2005 and 1995, respectively,2 3 are ideal to elicit attitudes of practising communities. Permission was granted from both agencies for use of their questions administered to women and men. We involved patients, professionals, FGM survivors and activists to ensure questions were relevant to a UK population.

This study is the first to develop the Unicef/USAID household surveys for a UK population. Our National Institute for Health Research-approved study, conducted from April to October 2016, was cross-sectional and focused on attitudes towards FGM using a written questionnaire. Participants consisted of English-speaking women and accompanying partners accessing specialist FGM services at two London hospitals. Those who agreed received an information sheet, consent form and questionnaire to complete in a private clinic room, after their clinician appointment.

Ninety eligible patients attending 11 clinics were approached and 54 participants recruited (51 female, 3 male). Forty-nine of the 51 (96%) female participants reported they had undergone FGM with half aged between 5 years and 10 years at the time. Twenty (39%) participants didn’t know which FGM type they had, but 15 (29%) said they had been cut with some flesh removed. Forty-eight participants (89%) reported they thought FGM should stop (95% CI 0.81 to 0.97), and none stated that FGM should continue. Seventy-two per cent (39/54) knew FGM was illegal in the UK with 22% not knowing and 6% of answers missing. Four participants reported that FGM caused no danger to women’s health.

The study was limited by lack of funding, no translators and poor clinic attendance leading to some patients’ exclusion. Patients who did not engage may have different views to participants. Male recruitment was particularly poor. Results cannot be generalised, due to the small sample and likely bias. However it demonstrates general opposition to FGM by participants but identifies significant gaps in participants’ understanding of UK law and FGM-related health risks.

We have shown that Unicef/USAID questionnaires can be adapted for UK use and suggest a UK-wide study regarding attitudes towards FGM to better inform work to empower communities to end the practice of FGM.



  • Contributors PC helped collect data, analyse the data and edit the manuscript. ML created the protocol and study documents, obtained the relevant approvals for the project, collected data, analysed data and wrote the manuscript. ML had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. GH is the chief investigator for the study and helped create the study—including protocol/study documents, ethical approval, sites for data collection and data analysis. SC advised on the design and analysis of the study, and critically revised the manuscript and contributed to the final draft. DH conceived the study, and critically revised the manuscript and contributed to the final draft.

  • Competing interests None declared.

  • Ethics approval The West Midlands – Coventry and Warwickshire Research Ethics Committee (ID: 16/WM/0158).

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Presented at This research was presented orally at the Royal College of Obstetrics and Gynaecology World Congress, March 2017.