As a nursing student, Grace McAleer from Northern Ireland, now a newly registered nurse, was always interested in history, equality, women’s health and “any type of injustice or abuse among any group,” she says.
“I was always reading and researching. As soon as I read about female genital mutilation [FGM] I went down a rabbit hole. I needed to know what people were doing about it.”
FGM is defined by WHO as: “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.”
Internationally recognised as a violation of human rights, FGM has no health benefits for girls and women, and it can cause serious harm including death. It can, according to WHO, cause severe bleeding and problems urinating, and later cysts, infections, as well as complications in childbirth and increased risk of newborn deaths.
Practised in around 30 countries across the world, it’s estimated that around 200 million women and girls alive today have been subjected to FGM with a further 3 million girls estimated to be at risk of FGM annually.
The lasting physical, psychological, and psychosexual trauma can result in lifelong conditions impacting on the health and wellbeing of women who have been subjected to FGM.
To change something, you first need to understand it
While some health care professionals work closely with communities that have practised FGM for generations, others may rarely come across it. Regardless of your role, Grace says, it’s vital everyone has some awareness of FGM.
“To change something,” Grace says. “You first need to understand it.”
When Grace started her Open University degree course, she says that FGM wasn’t on the curriculum, so she approached her tutors to question it.
“They were really supportive – they applied for funding to extend learning of FGM, which was successful, and then they* asked me to collaborate with them on a resource for the Open University,” says Grace.
“The Open Learn Resource – a learning resource to raise awareness about FGM among nursing and midwifery students – will soon be accessible to all nursing students as part of the curriculum, which is brilliant,” Grace adds.
As a student Grace also successfully applied for an RCN Northern Ireland Gabrielle Award bursary which provides nursing students with the opportunity to explore an issue they’re passionate about.
The bursary enabled Grace to fly to London and complete training with The National FGM Centre and visit the Sunflower Clinic, a specialist FGM clinic in London, where she got to shadow clinical experts.
Meeting the people working and being cared for at the Sunflower Clinic – one of 8 clinics opened as an NHS England pilot scheme in 2019 – was quite a surreal experience. “It was just a tiny, but very welcoming, pocket of the hospital where I got to witness life-changing work from a small team that included specialist midwives, an in-clinic counsellor and health advocates,” Grace says. "I saw the women there being looked after so well and all in the most gentle and sensitive way.”
Just because it’s not mandatory doesn’t mean we should ignore it
When Grace went home to Northern Ireland, she looked for similar services. “I did find some within maternity but in the north of Ireland there are no services or support clinics for women who have had FGM who are not pregnant,” she says. “Those services should be here – if you could give my work a goal, that would be it.”
People need to talk about FGM more, Grace says. “In Northern Ireland there is a lack of understanding around what FGM is and the impact it has. As a community, we’re particularly bad at talking about uncomfortable topics – be it sex or genital health or trauma. The other issue we have is people saying that it doesn’t happen here or that these services aren’t needed.
“It’s a hidden abuse and you’re trying to prove something with no figures because nothing is recorded. We’ve got to make a change.”
In June 2023, Grace won the RCN Northern Ireland Nursing Student Award for her commitment to addressing the gap in health care provision for people in Northern Ireland impacted by FGM.
“It was a real privilege to even be nominated,” she says. “It’s opened doors, so I can highlight this issue further. It’s also revealed to me those people passionate about this area, and me to them, so we can work together.”
Now qualified and working as a nurse in gynae services, Grace’s mission to help women affected by FGM means that her ideal career path is to become a link nurse and FGM staff educator. “I want to see mandatory FGM training for all nursing staff and health care professionals,” she says. “That’s my ultimate aim.”
Grace still believes that knowledge is power. Her message to current nursing students? “Educate yourself as much as you can. There are so many tools out there like the national FGM website,” she says.
“If the opportunity is there to learn more, and save someone’s life, then do it. Just because it’s not mandatory, doesn’t mean we should ignore it.”
FGM: a safeguarding issue
Regardless of where you are practicing in the UK as a nurse, you may come across women, children and families from communities that may practice FGM, and it is part of your duty of care to have an adequate knowledge and understanding of the issues so you can respond appropriately.
Carmel Bagness, RCN Professional Lead for Midwifery & Women's Health, says: “FGM is child abuse and the practice is illegal across the UK, consequently it is a safeguarding issue, and nurses have a responsibility to make sure they understand their role in protecting women and girls from this traumatic activity.
“In England and Wales, there is a mandatory duty to report cases of FGM, and across the UK there are procedures in place for safeguarding children, young people and vulnerable adults, and everyone should be able and confident to use them in their practice.”
More information on the nurse’s role can be found in the RCN’s recently updated guidance Female Genital Mutilation: An RCN resource for Nursing and Midwifery Practice. Find more detail on the health risks and complications on pages 20 and 21 of the guidance.
In recognition of some of the specific issues faced in sexual health care and travel health services, the RCN has also published Female Genital Mutilation: RCN Guidance for Sexual Health Care and Female Genital Mutilation: RCN Guidance for Travel Health Services.
Find out more
The RCN believes that FGM should be a part of health education in all pre-registration and post-registration programmes for nurses, midwives, nursing associates and health visitors. Our resource Female Genital Mutilation: RCN Guidance for Sexual Health Care includes the key messages below.
- FGM is child abuse.
- FGM violates the human rights of girls and women.
- FGM is illegal in the UK.
- It is illegal to take a girl or woman out of the UK to have FGM abroad.
- Girls may be at risk of FGM at any age from birth onwards.
- Sexual health is a key area for identifying and supporting those affected by FGM.
- Safeguarding is everyone’s responsibility – ask directly about FGM.
- FGM is part of routine sexual health risk assessment.
Join the RCN Women’s Health Forum here.
Image of Grace by MT Hurson, Stills Photography.