FGM: Top gynaecologist hits out at ‘political’ prosecution for female genital mutilation

Has the DPP picked the right target for a landmark legal case against a barbaric medical practice? Jeremy Laurance talks to Dr Katrina Erskine

A leading gynaecologist has launched a devastating attack on the decision to bring the first prosecution against a doctor for female genital mutilation (FGM) in Britain.

Dr Katrina Erskine, consultant gynaecologist and head of obstetrics at Homerton Hospital, Hackney, said she was angered by the case selected for the first prosecution because it gave a “misleading” impression of FGM, and risked deterring other doctors and midwives from giving appropriate care to affected women.

Dr Erskine accused the Director of Public Prosecutions (DPP), Alison Saunders, of putting politics before the welfare of women by announcing the historic prosecution days before she is due to appear in front of the Home Affairs Select Committee at its hearing on FGM on Tuesday.

The DPP had been under intense pressure to explain why there have been no prosecutions in Britain despite 140 referrals to police in the last four years. “I cannot help suspecting she needs something to say,” Dr Erskine told The Independent.

Ms Saunders announced last week that the Crown Prosecution Service (CPS) had decided there was sufficient evidence to press ahead with the case against Dr Dhanuson Dharmasena, 31, a registrar in obstetrics and gynaecology at the Whittington Hospital, London, for allegedly carrying out FGM on a patient. Hasan Mohamed, who is believed to be a relative of the patient, has been charged with aiding and abetting the doctor.

FGM is normally carried out on young girls, but the charges in this case relate to an adult woman who had just given birth. The woman had previously undergone FGM and it was alleged that in repairing her vagina following the birth, Dr Dharmasena carried out FGM himself, the CPS said in a statement.

Read more: The first prosecution is a watershed moment
Thousands treated for effects of female genital mutilation

Campaigners have already hailed the first case as a breakthrough in their battle to drive out the practice, which is estimated to affect 140 million women worldwide.

But Dr Erskine’s criticisms, coming from a senior gynaecologist with wide experience of FGM, will alarm the CPS – which urgently needs a successful prosecution.

Dr Erskine said other obstetricians were outraged over the decision to prosecute and warned it would distract attention from the real problem of FGM – the removal of the outer genitals – as opposed to the repair of the vaginal opening after a woman who had previously undergone FGM gave birth. “I am really cross about this. We have a very high prevalence of women with FGM at the Homerton and we are used to dealing with it. FGM is horrendous and barbaric and no one is trying to pretend it is not.

“We heard about the prosecution on Friday and everyone is up in arms. It will put off midwives and doctors involved in caring for women with FGM and it distracts from where our main focus should be which is on driving out the real practice of FGM which is barbaric. I cannot help suspecting this has something to do with the DPP being up before the Home Affairs Select Committee and she needs something to say.”

FGM is carried out in varying degrees, normally before puberty. The most extreme “Type III” involves cutting the clitoris and labia minora (inner lips of the vagina) and sewing together the labia majora (outer lips) to leave a small hole through which urine and menstrual blood can pass.

Dr Erskine said: “The size of the opening varies. I have seen women with just a pinhole. It is usually big enough to have sex but not big enough for a baby to come out.”

At Homerton Hospital, women who have undergone this FGM are offered the opportunity to have the opening extended in preparation for the birth before the baby arrives in a process called defibulation. However, in some cases this is not done until after labour has started. After birth, stitching can be necessary to stem the bleeding, Dr Erskine claims.

“There is a world of difference between slicing off a woman’s clitoris and labia minora and putting some stitches in if a woman is still bleeding [after giving birth]. What do you do? You have to stop any bleeding and that inevitably involves some suturing [stitching]. It would be completely misleading to call this FGM. The end result might look like FGM but it is not. This is conflating FGM with how to treat women post-labour.”

FGM is widely practised in parts of Africa and the Middle East but the scale of the problem in Britain is hard to assess. The Metropolitan Police has reported receiving 140 “references” to FGM in the four years from 2009-13, and the National Society for the Prevention of Cruelty to Children launched a helpline last year after claiming 70 women and girls a month were seeking treatment for FGM.

Dr Erskine said: “I have yet to see anyone born in the UK who has had FGM. I know it happens, but it is rare. All the women I have seen with FGM were born outside the UK and were cut before they arrived here.”

The mistaken beliefs around FGM included that it was more hygienic, that a woman was guaranteed to be a virgin when she married, that it preserved fertility and that it made women more attractive. “Mothers inflict it on their daughters because they believe they won’t get a husband without it ,” she said.

“This is where we should be putting our efforts – helping women to understand why it is wrong. Not on some poor doctor who may or may not have put some stitches in the wrong place.”

A CPS spokesperson said: “The decisions to charge Dr Dharmasena and Hasan Mohamed were made in accordance with the Code for Crown Prosecutors following careful consideration of all the available evidence”

There is still scant evidence FGM is carried out much in the UK

The medical profession has a long and inglorious history of closing ranks to protect its own. That may be the first, sceptical response to the intervention by a senior gynaecologist in the historic prosecution of a doctor for allegedly carrying out FGM.

But before dismissing it, consider: the alleged assault was not carried out secretly, in a back street, on a young girl, but openly on an adult on an NHS maternity ward in a major London hospital, following a birth.

It did not involve the removal of the outer genitals, as FGM is normally understood, but apparently the suturing of the vagina following delivery on a patient who had previously undergone FGM.

The announcement was made by the Director of Public Prosecutions, who is under pressure, days before her appearance before the Home Affairs Select Committee today.

Katrina Erskine, the gynaecologist who has decided to go public with her concerns, has almost 30 years’ experience of FGM and is passionate in her denunciation of what she describes as a “barbaric” act. She fears a bungled prosecution could do more harm than good.

The campaign against FGM has caught fire in the past year, a credit especially to the brave victims who have spoken out about their own abuse to protect others.

But there are dangers in the rush to judgement. There is still scant evidence that FGM is being carried out in this country on any significant scale, if at all.

Dr Erskine points to subtle distinctions between the suturing of a vaginal opening for medical reasons following a birth and repeating FGM. If these distinctions are not clear, young doctors and midwives at the start of their careers may be fearful of intervening to help.

It would be a cruel irony if the first prosecution in Britain made the care of such women worse, not better.

Jeremy Laurance

Russia Today’s new UK channel began broadcasting yesterday. Discussions so far have included why Britons see Russia as ‘the bad guy’

New UK station Russia Today gives a very bizarre view of Britain

Left: An illustration of the original Jim Crowe, played by TD Rice Right: A Couple dressed as Ray and Janay Rice

By performing as African Americans or Indians, white people get to play act a kind of 'imaginary liberation', writes Michael Mark Cohen

ebooksAn unforgettable anthology of contemporary reportage
Arts and Entertainment
Hand out press photograph/film still from the movie Mad Max Fury Road (Downloaded from the Warner Bro's media site/Jasin Boland/© 2014 Warner Bros. Entertainment Inc.)
films'You have to try everything and it’s all a process of elimination, but ultimately you find your path'
Arts and Entertainment
Imelda Staunton as Dolores Umbridge in the Harry Potter films

New essay by JK Rowling went live on Pottermore site this morning


Top Gear presenter is no stranger to foot-in-mouth controversy

Arts and Entertainment
Keira Knightley and Benedict Cumberbatch at the premiere of The Imitation Game at the BFI London Film Festival
filmsKeira Knightley tried to miss The Imitation Game premiere to watch Bake Off
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

Day In a Page

The drugs revolution starts now as MPs agree its high time for change

The drugs revolution starts now as MPs agree its high time for change

Commons debate highlights growing cross-party consensus on softening UK drugs legislation, unchanged for 43 years
The camera is turned on tabloid editors in Richard Peppiatt's 'One Rogue Reporter'

Gotcha! The camera is turned on tabloid editors

Hugh Grant says Richard Peppiatt's 'One Rogue Reporter' documentary will highlight issues raised by Leveson
Fall of the Berlin Wall: It was thanks to Mikhail Gorbachev that this symbol of division fell

Fall of the Berlin Wall

It was thanks to Gorbachev that this symbol of division fell
Halloween 2014: What makes Ouija boards, demon dolls, and evil clowns so frightening?

What makes ouija boards and demon dolls scary?

Ouija boards, demon dolls, evil children and clowns are all classic tropes of horror, and this year’s Halloween releases feature them all. What makes them so frightening, decade after decade?
A safari in modern Britain: Rose Rouse reveals how her four-year tour of Harlesden taught her as much about the UK as it did about NW10

Rose Rouse's safari in modern Britain

Rouse decided to walk and talk with as many different people as possible in her neighbourhood of Harlesden and her experiences have been published in a new book
Welcome to my world of no smell and odd tastes: How a bike accident left one woman living with unwanted food mash-ups

'My world of no smell and odd tastes'

A head injury from a bicycle accident had the surprising effect of robbing Nell Frizzell of two of her senses

Matt Parker is proud of his square roots

The "stand-up mathematician" is using comedy nights to preach maths to big audiences
Paul Scholes column: Beating Manchester City is vital part of life at Manchester United. This is first major test for Luke Shaw, Angel Di Maria and Radamel Falcao – it’s not a game to lose

Paul Scholes column

Beating City is vital part of life at United. This is first major test for Shaw, Di Maria and Falcao – it’s not a game to lose
Frank Warren: Call me an old git, but I just can't see that there's a place for women’s boxing

Frank Warren column

Call me an old git, but I just can't see that there's a place for women’s boxing
Adrian Heath interview: Former Everton striker prepares his Orlando City side for the MLS - and having Kaka in the dressing room

Adrian Heath's American dream...

Former Everton striker prepares his Orlando City side for the MLS - and having Kaka in the dressing room
Simon Hart: Manchester City will rise again but they need to change their attitude

Manchester City will rise again but they need to change their attitude

Manuel Pellegrini’s side are too good to fail and derby allows them to start again, says Simon Hart
Isis in Syria: A general reveals the lack of communication with the US - and his country's awkward relationship with their allies-by-default

A Syrian general speaks

A senior officer of Bashar al-Assad’s regime talks to Robert Fisk about his army’s brutal struggle with Isis, in a dirty war whose challenges include widespread atrocities
‘A bit of a shock...’ Cambridge economist with Glasgow roots becomes Zambia’s acting President

‘A bit of a shock...’ Economist with Glasgow roots becomes Zambia’s acting President

Guy Scott's predecessor, Michael Sata, died in a London hospital this week after a lengthy illness
Fall of the Berlin Wall: History catches up with Erich Honecker - the East German leader who praised the Iron Curtain and claimed it prevented a Third World War

Fall of the Berlin Wall

History catches up with Erich Honecker - the East German leader who praised the Iron Curtain and claimed it prevented a Third World War
How to turn your mobile phone into easy money

Turn your mobile phone into easy money

There are 90 million unused mobiles in the UK, which would be worth £7bn if we cashed them in, says David Crookes