Re: Hidden Voices UK: Circumcised Women Speak Out (revised 11 Feb 2020)

10/02/2020 Comments Off on Re: Hidden Voices UK: Circumcised Women Speak Out (revised 11 Feb 2020)

On Saturday, 8 February 2020, the recently formed group, Hidden Voices UK, hosted a theatrical performance called “Judging without Knowing” at Oxford House in Bethnal Green, East London, followed by a panel and open discussion with over 70 people who attended. It was organised in partnership with Women’s Inclusive Team, TALO, Queen of Sheba International, and Acta Community Theatre Bristol.

The event was one of a number of responses to the 17th anniversary of the UN’s 6 February International Day of Zero Tolerance for Female Genital Mutilation (FGM), and a ground-breaking one.

The members of Hidden Voices are increasingly concerned about how the criminalisation of FGM (also referred to as female genital cutting or FGC) is negatively affecting African communities living in the UK, particularly women and girls from Somali communities. Hidden Voices say that instead of being able to focus on whether any cases of FGM are even taking place in the UK, their group is having to focus on unethical and unnecessary referrals for child protection and helping innocent women to get back their children, who have been taken into care. They say: “The massive increase in referrals has put all on a hopeless path, and we have decided we must go public and expose this injustice.” Hence this play and public event.

The play, “Judging without Knowing”, was created entirely by Somali women working with actors from Acta Community Theatre, Bristol. It highlights the damage caused by a now common narrative that surrounds FGM in the UK – a combination of victimhood, stigma and criminalisation. The performance puts mothers and daughters at the heart of the issue and shows how women who were “victims of FGM” (mothers who were cut as children, almost all in Somalia in the last century) are now being pre-emptively criminalised by the assumption that they will have their daughters or granddaughters cut too. This narrative is promoted not only by the Tory Government and in recent law and new regulations against FGM, passed by the Tory Government, but also by prominent anti-FGM NGOs who have received funds from the Tory Government, and others who are promoting this narrative across the country. In my opinion, this is a new and insidious form of racism – supporting some African diaspora groups to stigmatise other African diaspora groups.

Through the real-life stories of two women, one with a young daughter and one with a newborn daughter, the play depicts the impact that so-called safeguarding policies have on families who are accused of carrying out this practice without any concrete evidence that they are planning to do so, and who are not believed when they insist they have no intention of doing so. What becomes clear is that the women are suspected of intending to carry out this crime only because of their racial, ethnic and cultural background and their own history of FGM as children. This “suspicion” is a form of racial profiling. It is unethical and discriminatory and should be rejected.

The play was followed by a panel, chaired by author and journalist Ella Whelan, which included:

– Zainab Nur, founder of Hayaat Women’s Trust in Cardiff,

– Bríd Hehir, researcher and author of the blog Shifting Sands,

– Yasmin Aslam, senior project officer at Ashiana in Sheffield who works with ethnic minority and refugee communities who have been affected by violence and abuse, and

– Janet Fyle, professional policy advisor, Royal College of Midwives.

There was also an open and rich discussion between the panellists and many well-informed members of the multi-ethnic audience, including women from FGM-affected communities, researchers, health professionals and advocates involved in addressing FGM in diverse ways. It became clear that women and their families and communities are being harassed by “safeguarding”, which is seriously harmful to children when it is not required or justified.

There were many crucial issues addressed. These are the ones I focused on:

1. What does “Zero Tolerance” mean in practice as opposed to being a slogan? What is the relationship between this and the assumption that everyone is guilty unless proven innocent, and that an assumption of guilt means it’s OK to take children into care without concrete evidence that they are at risk – that is, on the basis of “just in case”? Let alone to claim, as one person did in the meeting, that sometimes we just have to accept a few injustices to avoid children being hurt. This implies it is OK to hurt some children to protect others? Surely not.

2. When and why did the designation by the World Health Organization of FGM/C as a “harmful traditional practice” change to it being described as “child abuse”? FGM/C traditionally had, and still has, a cultural value in many African communities as a rite of passage from childhood into womanhood and readiness to be married. There were and still are many social penalties for refusing to circumcise girls, just as there are for not circumcising boys. At the same time, because of 40 years of campaigning against FGM/C, the practice has been declining globally, which is rarely acknowledged.  In 2013, UNICEF first published data to prove this, and to show that the more severe forms of FGM have also become less severe (and medicalised) in many places through concern to protect the child from harm but still be able to fulfil social requirements.

Here are some legally recognised definitions of child abuse:

– Child abuse includes physical, emotional and sexual criminal offences, as well as neglect, of a child. https://www.cps.gov.uk/legal-guidance/child-abuse-non-sexual-prosecution-guidance

– Harm to a child means ill-treatment or damage to their health or development, including the on-going failure to meet a child’s basic physical needs or psychological needs, or both; not providing adequate food, clothing and shelter; making inadequate childcare arrangements; and failure to protect a child from physical and emotional harm or danger; threat of injury, or an actual physical injury, such as hitting or shaking a child; constant or unjust punishment; withholding affection; telling a child that they are worthless; not giving a child opportunities to express their views; preventing a child from taking part in normal social interaction; letting a child see or hear the ill-treatment of someone else, for example, in a domestic violence situation; serious bullying, including cyber bullying, causing the child to feel frightened or in danger; sexual abuse; domestic abuse. https://www.citizensadvice.org.uk/family/children-and-young-people/child-abuse/what-is-child-abuse/what-is-child-abuse/

These definitions are about systematic, ongoing forms of ill-treatment, punishment and injury for its own sake. While everyone agrees that FGM/C is a harmful practice, it is also qualitatively different because it is a traditional ritual, symbolising initiation and belonging – the opposite of rejection or punishment.

The fact that male circumcision is not seen as child abuse by the same people who consider female genital cutting a form of abuse raises questions that few wish to confront or answer.

3. I participated in one of the first discussions at WHO about FGM and the terminology describing it. The decision to use the word “mutilation” – as opposed to circumcision – had the effect of adding moral condemnation, completely differentiating it from male circumcision, about which a comparable term might be “male penile mutilation”. I now believe we got it wrong from the start. USAID decided some years later to reject the term FGM and created the term female genital cutting (FGC) to avoid causing offence or distress to those who had had the procedure. Others insist on saying FGM, in that they believe the word “mutilation” is an accurate descriptor of what is done.

In the meeting, we heard that there was another term used by Somali women (Halal, https://en.wikipedia.org/wiki/Halal) that does not carry a meaning of condemnation, but indicates that it is a traditional practice.

4. There are no accurate data on the prevalence or practice of FGM across the UK. While absence of evidence is not evidence of absence, it is wrong to claim the numbers are “an epidemic” based on deeply flawed NHS Digital data, or total numbers of calls to the National FGM Centre, or on FGM Protection Orders issued, as some very vocal groups do. The “estimates of the numbers of girls at risk” that are being bandied about have not been reached through valid methods. They should not form the basis of any policy whatsoever. Epidemiology is the study of the incidence and distribution of health-related events. There are recognised methods for collecting data; accuracy is critical. It is past due time for proper studies to be carried out, and that means with anonymised methods.

5. Lastly, is criminalisation the best or most effective way to prevent and stop FGM? Although this has been an important topic of debate and discussion internationally, and is ongoing, it rarely occurs in Britain. Yet internationally there is an increasing level of questioning by human rights advocates of the value of imposing criminal sanctions as a way of protecting human rights – across the board, which can be applied with FGM. This has also been raised in relation to punishing sexual transmission of HIV, carrying condoms, using contraception, having an abortion, and buying and selling sex.

Few people have been prosecuted for FGM/C in any country, no matter what the prevalence of the practice. In the belief that prosecution has failed in the UK, the reasons for which deserves closer examination and explanation, a growing number of people who are still in pursuit of punitive measures, are calling for safeguarding of children. This includes taking children into care based on their mother’s historical FGM/C. This is punishment based on an assumption of guilt without a crime. It is a violation of justice and rights, and it is disingenuous to pretend otherwise.

6. There is much more to say. For example, this meeting didn’t even touch on the role of accusations of witchcraft that greatly influenced the decisions to convict in both the London trial in early 2019 and the Dublin trial at the end of 2019. Links to witchcraft must be rejected and excluded from prosecution. They are misogynistic, racist and obscene.

But the most important thing that happened in the Bethnal Green meeting was that nearly every African woman who spoke talked about being made to feel like criminals, about being stigmatised, blamed, treated with suspicion, and disbelieved. They insisted that FGM was simply not happening in their communities in the UK, as they have given up the practice. They asked why the Somali community was being targeted in particular, but no one knew the answer. They said their children were being traumatised by being singled out, questioned, and even having their genitals examined for signs of FGM. That children are being removed from their families and cannot understand why. The damage being inflicted on them and on their families is unconscionable, especially coming from people who claim they are the only ones who think protecting children is important.

This was a powerful, positive event. I hope the play and more discussions like this one can be held around the country and open up even more discussion of these issues among everyone who is affected, and everyone who is involved and concerned, from many perspectives.

Response to a Manifesto by Action:FGM, Dahlia Project, Savera UK, Magool, and The VAvengers

30/01/2020 Comments Off on Response to a Manifesto by Action:FGM, Dahlia Project, Savera UK, Magool, and The VAvengers

Your Manifesto has been shared with me as someone who has written on FGM and published papers on it in the journal Reproductive Health Matters while I was the editor.

I am absolutely not willing to sign your manifesto. Here is why:

First, it is incorrect in a number of places:

1. FGM is not an epidemic. An epidemic is: “the widespread occurrence of an infectious disease”. FGM is a harmful traditional practice. Moreover, its prevalence has been falling internationally since at least 2013, thanks to positive educational campaigns about why it is harmful and also because so many women in the communities where it was traditionally practised have decided themselves to stop the practice. Including in the UK.

2. You have distorted the figures about prevalence in the UK. You seem to be making the false assumption that all the daughters of all the women in the UK who had FGM as children in another country are at risk. There is absolutely no credible evidence to show this. You may believe these figures since so many other anti-FGM groups use them as well. But they are absolutely wrong and all of you should stop bandying them about without checking the source — because you actually do not understand what the source says.

3. Your description of FGM uses gross exaggeration. The severity of the cutting in many countries has been greatly reduced because of educational campaigns, and also because many people are going to medical doctors for it, the same as they are doing with male circumcision. You don’t even mention this. I would very much like to know where you got your information to claim that FGM is done many times, let alone more than once, to the same child. I have never seen any such published, peer-reviewed evidence.

4. Can you also provide published, peer-reviewed evidence that “A survivor may require invasive surgeries throughout her life as a result”. Do you have any evidence that this happens in the UK, since your call for action is about the UK?

5. Can you also provide published, peer-reviewed evidence that “FGM is part of a continuum of violence against women and girls”?

6. And again, what is your evidence regarding this claim: “Tackling FGM provides the pathway to eradicating these other forms of gender-based violence.” It’s a completely spurious claim, not least because you don’t define what you mean by “tackling FGM”.

It is highly irresponsible to make these claims without evidence. People’s lives are put at risk, children are being taken away from their parents for no reason, and whole communities are affected.

As regards “what needs to be done”:

7. You call for more convictions and yet if you look at the number of times the police and the DPP have sought convictions and failed, because they arrested people without credible evidence, because they were overly keen to prosecute, you might want to think again. Has it ever crossed your minds that the reason there have been next to no convictions is because FGM is not being done much in the UK? It’s not possible ethically or legally to assume risk exists because of ethnic origin or, for example, to treat everyone in an airport with suspicion, arrest them and put their children into care just because they are going abroad (which has happened).

8. You call for every female patient in the country to be questioned by GPs, thus criminalising all of us??? This is absurd and unethical.

9. You mention the recent conviction in Ireland. Are you aware that when the police were unable to identify anyone who could have carried out the alleged cutting, they said it must have been a witch? And are you aware that in the conviction here in London last year, the mother who was sent to prison was also accused of witchcraft, and false claims were made in court that FGM and witchcraft are linked, and that this successfully demonised her? Do you actually think this represents justice? Or do you yourselves believe in witches?

10. You want to pay people to report cases? Welcome to the Stasi in East Germany. Or don’t you know that people will lie for money.

I recommend you withdraw this manifesto because it contains unsubstantiated information, proposes nothing of value, discredits you and your groups, and if taken seriously, can do serious harm to innocent people because it calls for criminalising large numbers of people because they are women, and due to their ethnic and racial background. I think it’s shameful.

The Case of Dr Carlos Morín, Barcelona, Spain – “Hasta el final”

23/06/2016 Comments Off on The Case of Dr Carlos Morín, Barcelona, Spain – “Hasta el final”

The history of the persecution of Dr Carlos Morín, former director of the Ginemedex clinic in Barcelona, Spain, the staff of his clinic and the thousands of women who had abortions there began in Britain in 2004 and reached its climax, at least for the moment, on 17 June 2016, in the Regional Court of Barcelona, where during a re-trial ordered by the Supreme Court, three years after he and all his staff had been acquitted of all charges against them, Dr Morín was found guilty of having carried out 11 illegal abortions and a psychiatrist from the clinic, Dr Pascual Javier Ramón, was found guilty of signing the forms authorising the abortions.

What happened in between is the stuff of nightmares. The case was dragged through the justice system and the media for more than ten years by anti-abortion groups, who succeeded in having all Dr Morín’s clinics closed six years before he was even tried in court, and everyone who had been working in the clinics and the patients were investigated. Not only Dr Morín and his wife, who worked with him, but also many members of their staff were finally put on trial in 2012. In the interim, he was unable to practise his profession as a doctor and suffered from both public condemnation and bankruptcy, due to huge legal costs throughout the whole process.

The story began in Britain on 10 October 2004, when the Sunday Telegraph ran a story, based on “undercover” work[1] by a woman journalist pretending to be pregnant, that women beyond the legal time limit for abortion in England and Wales were being helped by the British Pregnancy Advisory Service (Bpas) to obtain abortions in Dr Morín’s clinic in Spain. Following an investigation by the Chief Medical Officer for the Department of Health, Bpas were criticised for the way the undercover call was handled, but were exonerated of any wrongdoing.

Moreover, according to the Chief Medical Officer’s report, the Barcelona newspaper La Vanguardia reported on 14 October 2004 that the Health Department of Catalunya had come to the conclusion that the Barcelona clinic “attends patients in a correct and legal manner”. The Catalunyan Department added that they had carried out an inspection which confirmed that the clinic concerned had provided services within the terms defined by the regulatory and legal system.

The British Chief Medical Officer’s report also stated: “My investigation has shown that it can be difficult for women to access late abortion services.” (Chief Medical Officer report, 2005)

Thus, no wrongdoing was found in either Britain or Spain. The situation did not end there, however. It was advanced further following an undercover visit to the Ginemedex clinic by a Danish public television crew, which was aired on TV in 2006 in Denmark, France and the Netherlands. That led to an investigation of a clinic in the Netherlands who, like Bpas, sometimes referred women with late second trimester abortions (25-28 weeks) and rarely a third trimester abortion who were beyond the legal time limit in their countries to the Ginemedex clinic. The ultra-religious group E-Cristians used the Danish TV show to call for an investigation of whether the Ginemedex clinic was doing abortions outside the law.

Under the law in Spain until 2010, abortion was legal up to 12 weeks if the pregnancy resulted from rape, up to 22 weeks in cases of severe fetal anomaly, and with no time limit if it was necessary to avoid a grave danger to the life  or the physical or mental health of the pregnant woman. Throughout this period, the Ginemedex clinic followed the guidelines for assessing the women who came to them in line with legal protocols. The woman was seen by a psychiatrist who also authorised that the abortion was legal and on that basis, the staff carried out the abortions.

According to Anne-Marie Rey, an abortion rights activist in Switzerland since 1971, who has closely followed the case from the beginning:

“Up to 2007, the Ginemedex clinic was a last resort for women who sought an abortion in advanced stages of pregnancy. Women were sent to Barcelona from many countries, when it was not possible to help them at home. Personally I gave his address to several women from Switzerland and they were always treated with respect and empathy. Yes, Dr Morín did interpret the Spanish abortion law liberally. But, in fact, he only applied the World Health Organization definition of “health” as “a state of complete physical, mental and social well-being”. And he applied this interpretation also in the case of desperate women who needed an abortion late in pregnancy, after 24 weeks gestation.”

As has been shown all over Europe, women requesting an abortion after 24 weeks of pregnancy are rare. In Britain, for example, in 2002, of the 175,932 abortions that took place, only 117 were after 24 weeks of pregnancy, that is, 0.06% of the total. (Chief Medical Officer report, 2005) This number and proportion are not unusual. The Chief Medical Officer’s report stated that in 2003, of all the patients seen within the 26 abortion clinics in Catalunya, only 812 patients were foreign (of whom only 14 were from the UK). 98.9% of the abortions on foreigners were at less than 22 weeks of pregnancy. In 3 cases it was in the 24th week and in 5 cases in the 26th week. (Chief Medical Officer’s report, 2005)

What came next, according to an article by the anti-abortion group Religion en Libertad, with information they say came from E-Cristians, would not have taken place without; 1) foreign media involvement, 2) follow-up by anti-abortion groups who kept written records and spent money, 3) the written testimony of a woman who attended the Ginemedex clinic, who was given protected witness status, and 4) a judge and prosecutor who decided to pursue the case “hasta el final” (up to the very end).

In 2007, as part of what became a long investigation, Dr Morín was charged with carrying out “illegal abortions”. He was jailed for two months until a judge ruled that he could be released pending trial, his four Ginemedex clinics were closed, and the clinics’ records, including the personal records of several thousand women, were confiscated for examination. The investigation, including interviews with all the staff and many patients, took six years. In September 2012, the case opened in the Audiencia de Barcelona, a regional court.

Between 2007 and 2012, when the case was finally heard, many other clinics in Spain were also affected. According to one report,[2] there were increased political inspections and administrative and judicial harassment for all abortion clinics and the women patients they cared for, and there was more radical anti-choice activity. Complaints were laid against other abortion providers in registered clinics. One clinic especially suffered “virulent persecution by both anti-abortion groups and by the government itself” for a time, until the situation was clarified.

Some 115 charges of illegal abortion were laid against 12 people, including Dr Morín, his wife (who helped to run his clinics), the psychiatrist Dr Pascual Javier Ramón, and 9 other physicians and nurses. There were hundreds of statements submitted by the prosecution and thousands of pages of judicial and police reports.

According to Religion en Libertad, up to 2012 when the case came to court, E-Cristians had spent 55,000 Euros, including for “extra-judicial actions” and the involvement of lawyers who “knew the terrain” and another 39,000 Euros for other costs (Defiende usted la vida? 2012) [3]

The case concluded with a verdict on 31 January 2013. The verdict was the acquittal of every person charged and on every charge, as reported in El País on 1 February 2013. The court accepted that the abortions were performed “with the consent and at the express request of pregnant women” despite some administrative irregularities. However, both the Prosecutor in the case and the anti-abortion groups who had accused Dr Morín and his staff (E-Cristians, Spanish Alternative, Thomas More Foundation and the College of Physicians of Barcelona) did not accept the verdict and appealed to the Supreme Court. Nine months later, the Supreme Court criticised the Regional Court’s judgement and ordered a re-trial in the Regional Court with different judges. They gave two reasons: first, they argued that the Danish television programme should have been taken in evidence, which the Regional Court had decided against doing. Second, they said that because Dr Morín exercised his right not to testify, the judges did not allow the prosecutor to read out the questions they had prepared to ask him. The Supreme Court thought, however, that these had to be made public and answered, in order to determine, as claimed by the Prosecutor, whether there were contradictions between the pre-trial and the trial evidence.

In March 2015, Dr Morín appealed to the European Court of Human Rights in Strasbourg. Within less than two months, the Court replied that they would not consider the case because the request did not comply with the requisites of admissibility of articles 34 and 35 of the Convention. (CEDH-Lesp11.00R, MMI/MCM/agz, Demanda No.13465/15, letter dated 30 April 2015) The presumption is that he had not exhausted his right of appeal to the very top of the Spanish court system.

The re-trial took place in the Regional Court of Barcelona in January-February 2016. This time, both Dr Morín and Dr Ramón were found guilty and sentenced – not to 390 years or 278 years in prison as the Prosecutor had asked for originally, but to 18 months in prison – and not for over 100 illegal abortions but for 11 illegal abortions. All the other defendants in the case were again acquitted. One could be forgiven for asking whether this new judgement was in fact safe, let alone just.

The final irony, however, is that according to El País of 17 June 2016, the sentence is not firm and can actually be appealed, once again, to the Supreme Court. [4] Thus, it would appear that in Spain, if ultra-religious, anti-abortion NGOs, who have no legal standing, don’t like the verdict of a court of law, the defendants can be tried again in the same court on the same charges by different judges, with different verdicts and opinions on what constitutes evidence, for as long as it pleases the courts to take, and the European Court of Human Rights is prevented by its own rules from considering whether the human rights of the defendants have been and continue to be violated.

A note of thanks to Carlos Morín – I join with Anne-Marie Rey who said on 20 June upon hearing of the verdict: “This latest sentence is a scandal. Thank you, Dr Morín, and all your staff, for all you did for those women! And for your standing up for the right of women to decide for themselves in difficult life situations. I do hope some help is still possible for Dr Morín in return.”

Acknowledgement Thanks to Anne-Marie Rey for providing a wide range of documentation about this history over several years and for her help in preparing this article. Any errors are the author’s alone.

References

An Investigation into the British Pregnancy Advisory Service (BPAS) Response to Requests for Late Abortions. A report by the Chief Medical Officer. Department of Health, September 2005.

Defiende usted la vida? El caso Morín ouede cambiar la historia del abortion…pero requiere dinero. http://www.religionenlibertad.com/articulo_imprimir.asp?idarticulo=22994. 5 June 2012.

Condenado por abortos ilegales un médico absuelto hace tres años, El País, 17 June 2016.

Visit the website of the International Campaign for Women’s Right to Safe Abortion, where this article was first published on 22 June, for the Annex that lists the 34 articles from El País covering this history from 2006 to 2016. The titles and first lines are in Spanish, translated by me, with the help of SDL Free Translation, into English. The articles are in Spanish.

Footnotes

[1] Some might call it attempted entrapment.

[2] Anonymous, personal communication, October 2011.

[3] This is a direct translation from the Spanish.

[4] “La sentencia tampoco es firme y puede ser recurrida, de nuevo, ante el Tribunal Supremo.”

Opposing the criminalisation of self-use of abortion pills

14/03/2016 Comments Off on Opposing the criminalisation of self-use of abortion pills

More officials in European governments seem to have discovered that women are buying MA pills over the internet and are having abortions outside their health systems. The immediate response to this is that these abortions are or should be “illegal”; indeed, they are illegal under the law in Ireland, the UK and Italy, if not also elsewhere. Two women were charged last year in Northern Ireland and are awaiting trial, three women are in prison in England (two for self-use of MA pills for very late abortions, one for selling them). Italy has just increased the fine for these abortions from €51 to €5,000-10,000. In Ireland the punishment is up to 14 years in prison. Women in the US have also faced criminal charges for this, and a case was heard in Australia as well, though in that instance the couple involved were let off.

Is the abortion rights movement ready for this new form of criminalisation of abortion to spread? I don’t think so, and I think we need to be talking about it quite urgently, especially in Europe.

A recent Guardian article about the extent of conscientious objection to abortion in Italy(http://www.theguardian.com/world/2016/mar/11/italian-gynaecologists-refuse-abortions-miscarriages), misses the point that for more than 90% of abortions, i.e. those in the first trimester, and indeed uncomplicated abortions up to 18-20 weeks, women don’t need a gynaecologist. Care from a trained nurse or midwife or other mid-level provider, with home use in the first trimester and in a day clinic in the second trimester are fine for uncomplicated abortions; WHO recommendations support this. It is primarily women with fetal anomalies and other later and complicated cases who need hospital-based abortion services under a gynaecologist, as these are understood today, and while it is crucial to provide and protect these services, they are not the model for all abortions.

Based on the evidence, we can push this a step further and say that for most women, abortion “services” should be offered mainly by pharmacies, and for the rest the health professionals who become abortion “providers” and the education and training they receive needs to change a lot. Pro-choice gynaecologists should be among those to take the lead in arguing this as they have the standing to be listened to.

We need to start arguing that medical abortion pills are safe enough that they should be as readily available for early abortions as emergency contraception is for the morning after. And we need to be informing women of this because most women probably don’t know it. Not the way we know it.

Do we even have a consensus on these points among ourselves? I’m not sure. But what I hope we all do agree on is that criminalising the self-use of MA pills is happening and must be opposed, and I believe urgently.

Most of the mainstream media articles on women self-inducing abortions quote one official or other that the pills are dangerous if used without the supervision of a health professional. The article about Italy is an example. There is a lot of evidence to the contrary that needs to be shared as widely as possible.

The history and role of the criminal law in anti-FGM campaigns: Is the criminal law what is needed, at least in countries like Great Britain?

24/12/2015 Comments Off on The history and role of the criminal law in anti-FGM campaigns: Is the criminal law what is needed, at least in countries like Great Britain?

This article was published online in Reproductive Health Matters 2015;23(46):145-57. DOI: http://dx.doi.org/10.1016/j.rhm.2015.10.001. Here is the abstract in English, French and Spanish:

Abstract

The history of campaigns against female genital mutilation (FGM) began in the 1920s. From the beginning, it was recognised that FGM was considered an important rite of passage between childhood and adulthood for girls, based on the importance of controlling female sexuality to maintain chastity and family honour, and to make girls marriageable. How to separate the “cut” from these deeply held norms is a question not yet adequately answered, yet I believe the answer is key to stopping the practice. Since the 1994 ICPD, national and international action against FGM has grown and resolutions have been passed in global forums which define FGM as a form of violence and a violation of children’s human rights. These resolutions have contributed to building consensus against FGM and developing national legislation criminalising FGM. Prosecutions or arrests involving FGM have been reported in several African countries and Great Britain, but apart from France, there have been very few. This paper summarises this history and how FGM has been criminalised. It argues that criminalisation may not be the best means of stopping FGM, but can have serious harmful effects itself. It calls for community-led educational information and more support for dialogue within FGM-practising communities, and argues that what is important is addressing the sexual and reproductive health consequences of FGM and gaining the understanding of women who have experienced it and their families as to why they should not make their daughters and grand-daughters go through it too.

Résumé

Les campagnes contre les mutilations sexuelles féminines (MSF) ont commencé dans les années 20. Dès le début, il a été admis que les MSF représentaient pour les filles un important rite de passage entre l’enfance et l’âge adulte, fondé sur l’importance du contrôle de la sexualité féminine afin de préserver la chasteté et l’honneur familial, et de permettre aux filles de se marier. Comment séparer la mutilation de ces normes profondément ancrées est une question encore sans réponse ; ce serait pourtant, à mon sens, une démarche essentielle pour mettre un terme à cette pratique. Depuis la CIPD, en 1994, l’action nationale et internationale contre les MSF s’est étendue et des forums internationaux ont adopté des résolutions qui définissent les MSF comme une forme de violence et une violation des droits fondamentaux de l’enfant. Ces résolutions ont contribué à dégager un consensus contre les MSF et à élaborer des législations nationales qui répriment cette pratique. Des poursuites ou des arrestations liées aux MSF ont été signalées dans plusieurs pays d’Afrique et en Grande-Bretagne, mais, à part en France, elles ont été très rares. L’article résume cette histoire et montre comment les MSF ont été sanctionnées par la loi. Il avance que cette pénalisation n’est peut-être pas le meilleur moyen de faire cesser les MSF et qu’elle peut avoir elle-même de graves conséquences. Il préconise une information éducative collective et davantage de soutien au dialogue au sein des communautés qui pratiquent les MSF. Il fait valoir qu’il est important de traiter les conséquences des MSF pour la santé sexuelle et génésique et de faire comprendre aux femmes qui les ont subies et à leur famille les raisons pour lesquelles elles ne devraient pas obliger leur fille ou leur petite-fille à en passer aussi par là.

Resumen

La historia de las campañas contra la mutilación genital femenina (MGF) comenzó en la década de 1920. Desde el principio, se reconoció que la MGF era considerada un importante rito de paso entre la niñez y la adultez para las niñas, basado en la importancia de controlar la sexualidad femenina para mantener castidad y el honor de la familia, y para preparar a las niñas para el matrimonio. Cómo separar el “corte” de estas normas tan arraigadas es una interrogante que aún no ha sido contestada adecuadamente; sin embargo, creo que la respuesta es clave para eliminar la práctica. Desde la CIPD de 1994, la acción nacional e internacional contra la MGF ha incrementado y se han aprobado resoluciones en foros mundiales que definen la MGF como una forma de violencia y una violación de los derechos humanos de las niñas. Estas resoluciones han contribuido a fomentar consenso contra la MGF y a formular leyes nacionales que penalizan la MGF. En varios países africanos y en Gran Bretaña se han reportado enjuiciamientos o arrestos relacionados con la MGF, pero aparte de Francia, ha habido muy pocos. En este artículo se resume esta historia y cómo la MGF ha sido penalizada. Se argumenta que la penalización quizás no sea el mejor medio para eliminar la MGF, ya que puede tener graves efectos dañinos. Se hace un llamado a la información educativa dirigida por la comunidad y a brindar más apoyo para el diálogo con las comunidades que practican la MGF. Se argumenta que lo importante es tratar las consecuencias de la MGF en la salud sexual y reproductiva y lograr que las mujeres que han pasado por esta experiencia y sus familias entiendan por qué no deben obligar a sus hijas y a sus nietas a hacer lo mismo.

What kind of research is needed for abortion advocacy?

24/12/2015 Comments Off on What kind of research is needed for abortion advocacy?

At the 5th Research Meeting on Unwanted Pregnancy and Unsafe Abortion, Mexico City, 28-30 September 2015, Silvina Ramos presented an excellent new CLACAI publication (in Spanish) on a renewed agenda for abortion research in the LAC region: “Investigacion sobre aborto en America Latina y el Caribe: una agenda renovada para informar politicas publicas e incidencias”. I was asked to comment in the session:

DATA FOR ADVOCACY

-We need to know more about what post-abortion care involves in order to showcase the failure of post-abortion care to resolve the serious public health problem of unsafe abortion. In 2012 an estimated 6.9 million women globally were treated for complications of unsafe abortion. In Latin America, new estimates of the rate of complications show a 31% decline between 2005 and 2012, from 7.7 per 1,000 women to 5.3 women per 1,000. (Singh et al, 2015) But this is still far too high and there is no excuse for it.

-As regards the incidence of abortion, we need to know more about pregnancy among girls aged 8-14 resulting from sexual abuse and whether or not they have access to safe abortion, including as a form of emergency obstetric care given how small they are. This emerged as an issue in Paraguay this year. There is little information on this subject though some research has been done (see http://conta.cc/1NNx4FD, http://conta.cc/1NN3sIn and http://conta.cc/1NMS9zS).

HEALTH PROFESSIONALS

-It is important to underscore the importance of the attitudes towards abortion of health professionals, and the importance of promoting training in abortion provision only for those who support women’s right to safe abortion. The current deficit in training should be a major advocacy issue. Why nurses should be less supportive to women needs to be better understood because abortion no longer requires doctors except in emergencies. Abortion care should be in hands of nurses and/or midwives at primary care and community level today.

-The prevalence of abortions among nurses/midwives and how they themselves are treated as patients might help to explain their views and bring them on board as a profession (http://www.rhm-elsevier.com/article/S0968-8080(07)30314-5/pdf).

-Attitudes towards 2nd trimester abortion are a particular problem. Can the number/proportion of second trimester abortions be reduced with better laws and services? Evidence from Sweden and Norway, particularly with good access to medical abortion, shows this can be done. If we knew why women have abortions after 12 weeks of pregnancy in more countries, it would contribute to change. However, this is not an issue of “women’s fault” but of systemic failures on the part of health and sexuality education, laws and policies, and health systems.

CONSCIENTIOUS OBJECTION

-Many who support abortion rights call for restrictions on conscientious objection but few oppose it altogether. Joyce Arthur of Canada and Christian Fiala of Austria have written several articles together and separately on this subject, opposing the whole concept.

-Sweden does not permit conscientious objection. This policy was challenged earlier this year at European level and their law was upheld.

-I agree with these views. I believe anyone who is unwilling to carry out an essential task in their job description should find another job. Abortion services are almost unique in allowing conscientious objection. It is a leftover of anti-abortion hegemony and should be removed.

PUBLIC HEALTH vs. HUMAN RIGHTS POSITIONS TO SUPPORT ABORTION

-I would like to disagree with one of the book’s authors that the public health arguments for safe abortion are less radical than those related to women’s bodily autonomy and rights.

-Public health arguments are not only relevant but also extremely powerful. I don’t think we use them enough anymore. Yet they are likely to have more resonance with health professionals.

-How to get past the huge, irreconcilable differences in thinking? Especially in the face of growing anti-abortion fanaticism?

RESEARCH FOR LAW AND POLICY ADVOCACY

-Campaigns for safe abortion often focus on calling for specific grounds for abortion to be decriminalised. For example, health grounds, rape, serious fetal abnormality, and in some countries in Latin America even for risk to the woman’s life to be permitted.

-I recently looked at the history of how abortion laws in several countries have changed over time, from almost complete criminalisation to allowing abortion at a woman’s request. This showed that a step-by-step process has taken place in some countries over a period of years, but often over decades. The current, limited law reform bill in Chile and recent examples in Africa show this has resonance as a way forward. But is it the only or best way forward?

-It would be good for this history to be studied in depth in many more countries, across both the 19th and 20th centuries and today.

RESEARCH ON ABORTION LAWS & GOALS

-For me, one of the biggest unresolved advocacy issues is whether we are seeking legalisation of abortion or decriminalisation of abortion.

-There a difference between these legal categories and we need to study it more.

-What reforms should we propose to our current laws on abortion that will lead to health system changes that will meets women’s needs and protect and fulfill their right to a safe abortion as part of their sexual and reproductive health and rights?

-In different countries, the answers may be different, depending on the origins of the laws, and more research and critical thought and analysis are needed.

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