Sexual and reproductive health to include Female Genital Mutilation

Dr Hilary CoolingDr Susanna Hall

Bristol Sexual Health Serviceswww.bristolsexualhealth.nhs.uk

• Global issues of womens’ reproductive health and rights

• UK scene setting• Sexual and reproductive health services and

migrant populations• Case study about Female Genital

Mutilation/Cutting (FGM) and the issues this raises

Global Perspective

• WHO: Reproductive Health and Rights• Core issues worldwide:– Choice of number and spacing of children– Choice of safe methods– Supported by education– Free from coercion

United Kingdom Perspective

• Background to sexual health services– NHS Regulations (1974)- enhanced confidentiality– Self referral to any clinic– Free treatment– Integration of sexual health services

– Support to use service – Clinics in localities around Bristol– Interpreters – face to face, telephone

Contraception and Family Planning Services

• All contraception is free in the UK• Wide range of methods available

• Long acting reversible contraception (LARC) provision is encouraged and supported by national guidance

Unplanned Pregnancy and Abortion

• Abortion legal in the UK• Requires 2 doctors’ signatures to agree the

grounds of the abortion• Majority of abortions are funded by the NHS

• Bristol increasing ease of access• Migrant issues including payment

Reproductive Health

• NHS Cervical Screening Programme to prevent cancer of cervix (“PAP smears”)

• Initially introduced in1964• Improved in 1988 by a computerised recall

system• HPV screening and immunisation

• Access through primary care or sexual health

Sexually transmitted infection including HIV

• National screening initiatives– Chlamydia Screening Programme

• National drive to increase numbers of women screened for HIV– Antenatal screening: chlamydia, HIV, syphilis,

Hepatitis B– Primary care

Psychosexual counselling

Specialist counsellors:• counselling for sexual problems• couple counselling

Sexual Assault

• Affects 1 in 4 women in their lifetime• ~ 95% do not report the assault• Sexual assault referral centres (SARCs)

developed nationally

• Bristol- “The Bridge”

Female Genital Mutilation (FGM)

• Female genital cutting• “female circumcision” partial or total removal of

the external female genitalia, or other injury to the female genital organs for non-medical reasons.

FGM and UK law

Female Circumcision Prohibition Act (1985)Female Genital Mutilation Act (2004):• FGM is illegal in England, Scotland and Wales• whether it is committed against a United

Kingdom national or permanent United Kingdom resident

• in the UK or abroad• maximum penalty of 14 years in prison

Estimated figures for those at risk of FGM

UK:up to 100,000 women10,000 to 20,000 girls

Bristol• Black African

population 7600 estimate (2011)

• More than 1600 girls 3-15 yrs in Bristol schools

Specialist advice for FGM

• Minority ethnic woman and girls clinic • Sexual health services – staff with specialist

skills • Community education/awareness raising

(with women and men)• Multi-agency network – services for women,

protection of children, schools, police

“Sahra” aged 28

She attends a sexual health clinic with her husband, both from Somalia, married for 2 years.

• She complains of pain and discomfort with attempts at sexual intercourse, and problems passing urine

• Examination shows vagina almost completely closed

FGM

• “opening” surgery – referral pathway to gynaecology for general or local anaesthetic procedure

• referral to midwife if already pregnant, for “opening” before labour

• protection of children (safeguarding) – daughters (not yet born), sisters, etc

Sexual and reproductive health

• pregnancy planning/unplanned pregnancy• Contraception• Sexually transmitted infections (STIs)• HIV• psychosexual counselling

Thank youAny questions?

Further informationFORWARD (UK)http://www.forwarduk.org.uk/key-issues/fgmWorld Health Organisationhttp://www.who.int/topics/female_genital_mutilation/en/

United Nations Population Fund (UNFPA)http://unfpa.org/gender/practices1.htm Integrate Bristolhttp://integratebristol.org.uk/documentary/

South West Safeguarding and Child Protection Procedures

http://www.online-procedures.co.uk/swcpp/contents/guidance-child-protection/female-genital-mutilation/

The Bridgewww.turntothebridge.orgFaculty of Sexual and Reproductive Healthcarewww.fsrh.orgRoyal College of Obstetricians and Gynecologistswww.rcog.org.uk

National Institute for Health and Clinical Excellence www.nice.org.uk

NHS Cancer Screening Programmeswww.cancerscreening.nhs.ukNational Chlamydia Screening Programme IPPF www.ippf.org/enfpa www.fpa.org.ukMedical Foundation for AIDS & Sexual Healthwww.medfash.org.uk