HL Deb 10 November 1998 vol 594 cc730-50

8.47 p.m.

Baroness Amos

My Lords, the Unstarred Question will now be subject to a one-and-a-half hour time limit. This change does not affect the maximum time available to the noble Baroness, Lady Gould of Potternewton, or to my noble friend Lord Hunt of Kings Heath, but it increases the maximum time available for other speakers from three minutes to six minutes. However, noble Lords who have prepared shorter speeches will earn undying gratitude if they resist any temptation to lengthen their speeches.

Baroness Gould of Potternewton rose to ask Her Majesty's Government what action they have taken, following the Prohibition of Female Circumcision Act 1985, in relation to education, prevention and prosecution under the Act.

The noble Baroness said: My Lords, I was prompted to revisit the issue of female genital mutilation after listening to Waris Dirie, a United Nations special ambassador on the subject, at a meeting of the All Party Group for Population, Development and Reproductive Health that was held earlier this year.

A model born in Somalia, Waris described how she was circumcised at the age of five and promised in marriage to a man aged 60; how she fled her village at the age of 14 to avoid the wedding and sought refuge with relatives in Britain. She said of her campaign to outlaw all female genital mutilation, and I quote: I have seen them suffer and die from FGM. I was strong enough to survive and I want to make a difference. I can talk because I have experienced the pain".

The realities of FGM are grim. Reading about it makes you shudder; watching videos of the practice makes you sense the horror; but we have to try to think of the horror for the poor girl, not only at the time of her mutilation but for the rest of her life. Sex will bring only pain, and childbirth will be unbelievingly agonising and dangerous.

In 1985 the Prohibition of Female Circumcision Act was passed, due to the persistence of those noble Lords who continued to raise the issue, and I am pleased that many of them are actually entering the debate tonight. It is now time to examine the progress of that legislation to determine what measures have been taken in education and guidance to eliminate female circumcision, whether reported cases have been followed up and whether prosecutions have taken place. In fact, has the 1985 Act had any effect at all?

It would appear that in spite of the possible five-year prison sentence, the practice continues, being performed illegally in Britain on babies and young girls, being performed not necessarily by medically qualified practitioners, and often without an anaesthetic and using unsterile instruments.

The BMA estimates that over 3,000 young girls are circumcised in Britain each year. FORWARD, the leading campaign organisation in this field, estimates that up to 15,000 girls are at risk. But because of the great secrecy and wall of silence surrounding the practice, it is difficult for cases to be brought to court.

In 1993, a Harley Street medical practitioner was brought before the General Medical Council, which correctly took the view that, if practised for social, religious or other ritual reasons, FGM was an unethical practice. The doctor was struck off, but no prosecution followed. Just a year ago, two cases were reported in the media of a doctor in Manchester who for £50 would agree to perform this mutilation of young girls and of a steel worker in Sheffield with no medical training whose charges ranged from £40 per child in Sheffield, £45 in Liverpool and £70 in London. Perhaps my noble friend the Minister will indicate whether any action is likely to follow.

FGM is defined as, a traditional procedure which entails partial or total removal of the external female genitalia and/or injury to the female genital organs for non-therapeutic reasons". That definition covers three types of operation which vary in the degree of mutilation. However, the health consequences of the practice, while varying according to the procedure used, can be, and usually are, serious. They range from damage to the external reproductive system; uterus, vaginal and pelvic infections; cysts; infertility; and complications in pregnancy and childbirth.

Of equal consequence are the psychological scars. The practice can leave a lasting mark on the life and mind of the girl who has undergone such a trauma. Such psychological complications may be submerged deep in the child's subconscious and can become the cause of behavioural disturbances. Psychological support is essential for those girls living in this country who realise how much damage FGM has done to them—girls who are holding onto their secret, feeling guilty and isolated, and who in the longer term may grow up suffering feelings of incompleteness, anxiety, depression, chronic irritability and frigidity.

So what are identified as the justifications for carrying on this barbaric practice, euphemistically known as "Cutting the Rose"? It is believed to ensure virginity until marriage, to maintain family honour and to ensure a sense of belonging to the group, and to be a way of controlling women's sexuality and keeping them subordinate to men. Women are made to believe that it will increase their husband's enjoyment of the sexual act, although it might cause the woman great pain.

But why? It is uncertain when FGM was first practised. However, there is no doubt that its roots are complex and numerous. It certainly preceded the founding of both Christianity and Islam. The Koran and the Bible do not require it. It crosses religious, ethnic and cultural lines. But customs, rituals, myths and taboos have perpetuated the practice, even though it has maimed and killed untold numbers of women and girls.

It was only in the late 1970s that the silence was broken.

International organisations and conferences have repeatedly made statements on the dangers of FGM and their support to eradicate the practice. A number of human rights treaties have condemned it, as did the decisions of the Cairo and Beijing UN conferences.

All societies and cultures have norms of behaviour and traditional practices which it is difficult to break. But culture is not static, it can be adapted and reformed. It is possible to give up harmful practices without giving up meaningful aspects of one's culture.

I give two examples. Last December, Egypt's highest court, the Council of State, ended a controversy that started in 1959, when it ruled that the ritual of FGM was not an Islamic religious practice authorised by the Koran and banned its use. This ruling has given great encouragement to anti-mutilation campaigners throughout Africa.

Creating a cultural alternative to female circumcision is the aim behind my second example—an example that could so easily be followed in this country. A recent project in Kenya has succeeded in doing away with the harmful elements while maintaining its cultural origins. The first "alternative graduation" ceremony was held in August last year. Thirty girls and their mothers danced and sang songs, songs with a "circumcision through education" theme. Holding this non-physical ceremony was possible only because of a changed attitude among men, for in Kenya, it is the fathers who make the decision on whether or not their daughters should be circumcised, and this work among men is continuing.

But meanwhile, refugees to this country continue the practice. Many of the women involved suffer acute isolation from mainstream societies and services caused by gender, language and cultural barriers. Any intervention must therefore be culturally appropriate, tactful and sensitive and in no way make the women feel ashamed or guilty of their culture.

There is a need to provide advocacy materials: where to go for support in the community, how to access those services available through the NHS, social services and education authorities—information which should be available through both men's and women's community groups. Equally, there must be greater awareness by health professionals, social workers, community workers and teachers. There needs to be multi-agency working, with an extension of training for professionals on FGM prevention and rehabilitation.

Supported by the Department of Health, FORWARD and many other community and health groups have over the past decade raised awareness and helped to place the elimination of FGM on the agendas of government, local authorities and community agencies. As a result of this work, we in the UK now have one of the best models for building the elimination of FGM into the mainstream activities of women's health and child protection. But much more needs to be done. With discretion and sensitivity, families have to be influenced, for FGM will be eradicated only when parents wish to provide their daughters with the freedom, status and physical safety they deserve.

FGM is universally unacceptable because it is an infringement of the physical and psycho-sexual integrity of women and girls and is a form of violence against them. It is a human rights abuse, and those found guilty of it must be condemned.

Baroness Nicholson of Winterbourne

My Lords, before the noble Baroness sits down, perhaps I may ask whether she is aware of an initiative by the Commonwealth Secretary-General, Chief Anyaoku, who is to place this matter before a meeting of Commonwealth Health Ministers next February, as he indicated at a meeting last week. Will she encourage the Government to support that move?

Baroness Gould of Potternewton

My Lords, I shall certainly do so. I did not know about that initiative and I am delighted to hear about it. Any move and any measure that we can take in order to eliminate this practice is absolutely essential.

8.57 p.m.

Baroness Rendell of Babergh

My Lords, as the House has heard from my noble friend Lady Gould, female circumcision should probably be called female genital mutilation. It may be helpful for me to describe these dreadful procedures. They consist of three related but distinct practices: clitoridectomy or clitoral excision: female circumcision; and infibulation or Pharaonic circumcision. The first, as the term suggests, is the removal of the clitoris; the second usually involves clitoridectomy and excision of the labia minora; whereas the third involves removal of the labia majora and the mons veneris and often the clitoris as well, and subsequent suturing of the remnants of the labia majora. In other words, as far as Pharaonic circumcision goes, it means the entire removal of all a woman's external genitalia, followed by stitching up the tissues over the wound. These operations are currently carried out in many African countries—the rate in Somalia is 98 per cent. of the female population—and are to a great extent irreversible, with effects that last a lifetime.

As noble Lords have heard, FGM is not confined to Moslems, but is also practised by Catholics, Protestants, Copts, animists and non-believers. The belief that it was demanded by Islam has no foundation in fact. Justifications include the preservation of virginity; chastity; hygiene and cleanliness; honour; and custom and tradition. Men in Somalia and other parts of Africa will not marry women who have not undergone female genital mutilation. However, among immigrants more and more men are becoming opposed to the practice, though they still consider that this is women's business and not for them to interfere with.

The World Health Organisation has consistently advised that FGM should not be practised by any health professional in any setting. Its position rests on basic ethics of healthcare where unnecessary body mutilation cannot be condoned by health providers.

The Act of 1985 does not make provisions to prohibit children being taken out of the country, but under Section 47(1) of the Children Act 1989, local authorities have a duty to investigate and protect children who are at risk of FGM and, if need be, apply to the court to take prohibitive steps in order to prevent parents removing a child from the UK so that mutilation can be carried out abroad. Parents' desire for mutilation to be practised on their daughters is so great that if they cannot have the operation performed by doctors in the healthcare system, families have been known to pool resources in order to bring traditional "circumcisers" from home countries to perform such procedures clandestinely.

A friend of mine who is a GP told me yesterday that he often sees examples of FGM in his north London surgery among immigrants from Somalia and the Sudan. Recently he saw a young woman who was pregnant and so grossly mutilated and scarred that it was impossible for her to give birth normally and a Caesarean was inevitable in her case. In the United Kingdom it is important for GPs to be aware of the problem and know which ethnic groups are at risk. Women, quite naturally, do not care to talk freely about it. "Are you closed?" is a turn of phrase well understood by the Somali community. Doctors should be alert when told of menstruation and urination problems in girl children. It would be a good idea, for example, if an understanding of FGM were to be incorporated in basic nursing training. Teachers may be told by a child in their classes that she is going on a "special holiday" to the home country, or even on a holiday she admits she is not looking forward to because she knows the reason why she is being taken. This may mean that she is going back to her parents' original community where FGM will be carried out on her.

All newly arrived communities who practise FGM should be informed of child protection mechanisms and legislation against the practice, given education on the rights of children and how risks and abuses can be reported to responsible authorities. The Government's Women's Unit aims at refocusing energies to make a difference in the lives of ordinary women rather than high achievers. This is an area which should particularly come under that unit's scrutiny. The defence that the practice of FGM is cultural and traditional cannot be used in the face of such a huge spread of human suffering.

9.2 p.m.

Baroness Thomas of Walliswood

My Lords, this is such a shattering subject that it is very hard to speak of it at all. But I think we should all be grateful to the noble Baroness, Lady Gould of Potternewton, for raising it in the House tonight. It is something with which we should concern ourselves.

I wish to reinforce the point she made that female genital mutilation is an offence against human rights, and particularly against the rights of women. It is totally unacceptable, as well as illegal, that in this country 3,000 girls should be brutally assaulted in such a way as to ensure that their experience of sexual activity and childbirth is adversely affected for the whole of their lives. After all, paedophilia—another kind of assault—rightly arouses enormous concern. How much more concern should we feel on the subject of female genital mutilation, the pain of which never leaves the adult who is subjected to it as a child.

It is the press which has brought home the dangers of paedophilia to the general population by lifting the taboo which used to exist on public discussion of such subjects. It is the secrecy which surrounds female genital mutilation which is the chief protection of those who continue to practise it. So I hope that a way can be found to involve the press in publicising the matter, but without causing an unsuitable arousal of racial passion.

The continued practice of this offence against human rights in our country is in vivid contrast to the concerns recently expressed by British doctors that children, even young children, should be fully informed of and, if possible, should consent to those necessary therapies which cure but which have dangerous or disagreeable side effects.

It could be argued that we should avoid criticism of female genital mutilation which occurs outside our country. But I cannot accept that attitude, even at the risk of sounding like a so-called cultural imperialist. The annual toll of 2 million cases worldwide simply must not be tolerated. This dreadful practice is indeed a sophisticated form of torture, practised against girls so as to subjugate them as women. Torture is a crime recognised and proscribed at international level.

Indeed, colleagues in the International Network of Liberal Women want to see FGM or the fear of it recognised as a reason for granting asylum. This is not an entirely new approach, but it would reinforce the efforts of those who campaign to eradicate this practice from within those communities which promote or tolerate it. I hope that the Government will give it a sympathetic hearing. However, I recognise that today's debate is about our responsibilities within our own country.

I thoroughly support the motives of the noble Baroness, Lady Gould, in raising the matter and I look forward to a reply which takes us forward towards eradicating this terrible practice.

9.5 p.m.

Lord Ahmed

My Lords, I begin by thanking the noble Baroness, Lady Gould of Potternewton, for raising this very important question of education, prevention and prosecution under the Prohibition of Female Circumcision Act 1985.

I agree wholeheartedly with the noble and distinguished Baronesses who have spoken before me. Noble Lords have already been told that, according to a report in the Observer last year, the British Medical Association estimated that 3,000 to 4,000 young girls are circumcised in Britain every year.

FORWARD, the Foundation for Women's Health Research and Development, estimates that up to 15,000 girls are at risk of mutilation in Britain. The World Health Organisation and UNICEF have reported that today the number of girls and women who have been subjected to female genital mutilation is estimated at over 130 million worldwide and a further 2 million girls who are annually at risk of this practice.

Egypt, Ethiopia, Kenya, Nigeria, Somalia and the Sudan account for 75 per cent. of all cases. In Djibouti and Somalia 98 per cent. of girls are mutilated.

FGM (female genital mutilation) was introduced to these parts of Africa from ancient Egypt. Circumcision was practised during the reign of Amen-en-heb in the 15th century BC. The ancient Egyptians attached religious significance to circumcision since it was considered a hygienic necessity. The Pharaonic circumcisions are practised by all religions in these countries. However, it is sometimes wrongly associated with Islam. It has already been said that Moslem scholars have made it very clear that the practice of mutilation is strictly forbidden in Islam. I quote from the Koran. Allah the Almighty, commands them what is just and forbids them what is evil, and allows them as lawful what is good (and pure) and forbids them from what is bad". This practice is demanded in male-dominated cultures to preserve female chastity and marriageability and supposedly to heighten male pleasure. This is also un-Islamic because it deprives the female of the same pleasures. More importantly, female circumcision has harmful physical and psychological effects. It causes prolonged bleeding, infections, painful sexual relations throughout life, infertility and death, and yet there is not a single benefit that results from this odious crime.

Since female circumcision is neither a requirement nor obligatory it is dangerous and criminal and must stop. Women and community groups need to be made aware of and educated about the facts of this dreadful crime and practice. Rogue nurses or GPs who charge £50 a time to carry out this backstreet practice must face prosecution under the Prohibition of Female Circumcision Act 1985.

9.10 p.m.

Baroness Masham of Ilton

My Lords, I am very pleased to follow the noble Lord who has just spoken. In 1985 I was pleased to take the Prohibition of Female Circumcision Bill through your Lordships' House which had been introduced in another place by the honourable Member for Broxbourne, Mrs. Marion Roe. Everyone interested in the matter worked very hard in 1985 to obtain a satisfactory Act of Parliament to ban and make illegal female genital mutilation in Britain. It constitutes all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs, whether for cultural or any other non-therapeutic reasons.

I have often wondered what progress has been made since 1985 to eradicate this vile practice. I am most grateful to the noble Baroness, Lady Gould of Potternewton, for giving noble Lords the opportunity to debate this matter tonight. The noble Baroness champions women's rights. I am horrified to think that our work on legislation to ban this degrading and dangerous practice has been flouted. The practice goes on in Britain and no one appears to have been punished. Why not? Very often it is the press that opens people's eyes and hearts.

Many of us like old traditions, such as the Lord Chancellor wearing breeches. It does not hurt anyone if he wears breeches or trousers. But for young girls and women in the short term female genital mutilation causes severe pain and shock, infections, urine retention and injury to adjacent tissues; and, in the long term it causes extensive damage to the external reproductive system, uterine, vaginal and pelvic infections, cysts and neuromas, increased risk of vesicovaginal fistulas, complications in pregnancy and childbirth, psychological damage, sexual dysfunction and difficulties in menstruation. Many young girls and babies die as a result of haemorrhaging. Sometimes the most barbaric instruments are used such as razor blades or broken glass.

I hope that the Government will be generous in supporting FORWARD (the Foundation for Women's Health, Research and Development) which helps to educate and make people aware of this practice. It is important to spread the word among many groups. I am pleased that clinics at the Central Middlesex and Northwick Park Hospitals, which have translation services in Somali and Arabic, help these people. Much more needs to be done and I hope that this debate will help in some way.

People use ignorance as an excuse to evade the law. The wicked grannies must be sorted out and confronted and the demand eliminated. Surely, the right of the child to a healthy and happy life is paramount.

France seems to have been more successful than Britain in penalising the guilty. Should we not have better links internationally and extend the legislation to make it illegal to take British born children out of the country for mutilating procedures? The World Health Organisation should make this a priority, as should all governments.

9.14 p.m.

Lord Rea

My Lords, 13 years ago I spoke on several occasions in support of the noble Baroness's Bill. At that stage, my role, as a doctor, was to describe in stark detail the process and effects of the practice. However, tonight the situation has been described so well by my noble friend Lady Gould and other noble Baronesses that I need not repeat it. My noble friend Lady Gould expressed the case so well that I shall compare her to the soprano in this rather macabre opera. She has performed the aria; we are merely the chorus, and perhaps not nearly as good singers.

Few of us who were involved in the passage of the Act in 1985 would have predicted that this harmful and cruel practice would greatly escalate in the United Kingdom rather than diminishing or being abolished, as we hoped would be the result of the law. The main reason for that escalation, as others have said, is the great increase in immigrants from countries where the custom is still deeply ingrained. Those from the Horn of Africa, especially Somalia, make up the majority.

This apparent failure of legislation to have much effect should not surprise anyone who has looked at past efforts to ban a widely prevalent practice which is thought to be socially undesirable. The so-called war against drugs is a prime example of where legislation has not worked, as was the disastrous attempt to prohibit the consumption of alcohol in the United States in the 1920s. In both cases the result was to increase the activity that was prohibited. The law on its own has proved to be a blunt and ineffective instrument. So although I support the periodic use of the Act to prosecute persons carrying out FGM—it is about time the measure was used—real progress will come only through education, and through that a change in the knowledge and attitudes of the communities where it is a problem. And that applies in Britain as well as those countries where the custom is prevalent.

To start the process of re-education we must assist and encourage those members of the ethnic group concerned who are fully aware of the problem and wish to become involved in the campaign to end it. The organisation FORWARD has been pioneering such schemes using trained members of the communities concerned. In that work I am aware that some support is received from the Department of Health. It would be helpful if the Minister could give details of the programmes supported by the Department of Health. How much is spent on them? Is it planned to expand those programmes? From the figures of FORWARD I suggest that that is very necessary judging from the escalation of the number of cases about which we hear.

We have already heard about one unwelcome practice which may to some extent be an inadvertent effect of the Act: that families take their children out of the country, ostensibly on holiday, and while in those other countries subject them to genital mutilation. I ask, as have other noble Baronesses, whether my noble friend thinks that the practice could be discouraged—for example, by suggesting to parents who are taking children to certain countries that they might be liable to prosecution if it is subsequently demonstrated that genital mutilation has taken place. It is problematic and difficult because that may prevent families from taking their children to hospital or to doctors for necessary treatment. It is a delicate subject, but I should be interested to hear the Minister's comments.

One of the difficulties which is hindering work to end the practice is the deep lack of awareness in the population of this country that it occurs. That is even the case among health workers, including doctors and nurses. There is a great need, in particular in areas with significant immigrant communities, to spread greater knowledge of the extent and harmful effects of FGM. FORWARD suggests in particular that not only health workers but also social workers, teachers and even school children should be made fully aware of the problem.

Although to a large extent FGM is practised by women on women, it is a feature of male dominated patriarchal societies where women are regarded as possessions. It is more common in societies where most women are illiterate. The surest way to bring the barbaric practice to an end is, first, to press for universal education and the end of female illiteracy; and, secondly, to press for the spread of information to both men and women—the men who have powerful positions in such societies—to end the disgraceful practice which still persists at the end of the 20th century.

9.21 p.m.

Lady Kinloss

My Lords, I am grateful to the noble Baroness, Lady Gould of Potternewton, for asking this Unstarred Question tonight. It is an important but very sad occurrence in the lives of many females, usually young children. The noble Baroness named three ways in which guidance can be given to help those who are likely to suffer female circumcision. She mentioned education and prevention, which I shall mention again later, and prosecution under the Act for those who perform the operation.

When my husband and I were living in Tanzania, an African nurse talked to me about the subject. Not only was she the mother of two small daughters, but as a nurse she was educated to a high standard. She was terrified that while she was working one day her mother, who looked after the children for her, would take them to be circumcised against her wishes. Having suffered badly herself in giving birth, she had no wish to put her children not only through the pain of childbirth but the trauma and pain of circumcision. She was not the only female person to talk to me on this subject. They and their female children who are the next generation growing up do not want this practice to continue.

Before taking part in previous debates in your Lordships' House, I spoke with African women who were living in this country. They did not want the practice to continue either. As regards prevention, it is very difficult for the younger people to protest. The grandmothers are usually the people who organise the ceremonies and selective people carry out the operations. The important aspect of prevention could be educating mothers and children in special classes to tell them the medical consequences during childbirth and the dangers from the operation itself. Perhaps the medical staff and others working with them could be female. I suggest that because most of them would not wish to talk to men on the subject. Of course, if essential, they would speak to their male doctor who, if they were living in a rural area, would probably be the only available person if they were in urgent need of help. All the same, their custom is to speak only with one of their own sex, so they will probably respond better to a woman. However, I am pleased to hear from the noble Baroness, Lady Gould, that men's attitudes are changing. That was also confirmed by the noble Lord, Lord Ahmed.

I ask the Minister whether the European Union is taking any action on the subject. If not, could it not be asked to examine the situation? It is a problem in Europe as well as in this country. Of course, it is a problem also in other parts of the world. Is the Minister aware that in France, for example, cases have been brought before the courts and sentences passed? Also in France, it sadly took the death of two little girls in 1982 to bring the issue before the public and so oblige the authorities to take a stand against that practice.

I have spoken on all the debates on this subject in your Lordships' House and feel sad that nothing has really happened to try to stop it. I understand that there have been no prosecutions so far. Will the Minister say what has taken place in the World Health Organisation on this subject? I understand that it has condemned the practice, but is that as far as it goes? Could it not take some sort of initiative in sponsoring help groups in different countries? I look forward to hearing the Minister's response.

9.26 p.m.

Baroness Uddin

My Lords, I too thank my noble friend Lady Gould for introducing this debate. I feel humbled by it and I can add nothing to the contributions made by your Lordships. I shall restrict my contribution to the role of the voluntary organisations.

I speak with no personal experience except the knowledge of the time in 1981–82 when Britain's first voluntary organisation was set up to help women who were coming to the attention of the health services at the time of childbirth. I take this opportunity to pay my personal tribute to the pioneering work of the London Black Women's Health Action Project whose dedication began the process in earnest which led to the legislation coming into effect.

It did a great deal of work in the area of advocacy, empowerment and education, which are some of the organisation's key objectives. The organisation was the very first hope of a helping hand for women involved in that extremely traumatic process.

The empowering and enabling role of voluntary organisations is acknowledged in the arena of women, disability and race. It will come as no surprise that the huge burden of educating and empowering women to say "no" remains largely in the hands of voluntary organisations such as the London Black Women's Health Action Project and others. I salute the excellent work of those grass-roots organisations without which many more women would be added to the statistics which we have heard.

It is inexcusable that the legislation was enacted without the provision of adequate financial resourcing of the voluntary organisations, and others, to undertake the most important task of education. However, I hope that today we shall hear from the Minister how we propose to rectify some of the past mistakes, especially in relation to voluntary organisations and funding. Perhaps he will tell the House how many projects have been funded; what is proposed in terms of taking on board the 3,000 or so young women with whom we need to work; and how we are working with the child protection legislation to protect children.

There is an enormous amount of work to do in the area of gathering statistics to inform us about how many children we have managed to protect. In the true spirit of joined-up action, I urge the Government, to ensure it enables the voluntary organisations to take the lead role in education and empowerment of women from within. For this is the only way that change in attitudes and practices will prevail. Only then will women feel able to decide to say "no" to that violation of their human rights and bodies.

9.28 p.m.

Baroness Jeger

My Lords, I begin with an apology from the noble Baroness, Lady Cox. The noble Baroness and I both supported the original Act in 1985 and she has asked me to apologise for the fact that she cannot be here this evening because she is still working on the implementation of that legislation. We were most enthusiastic; indeed, we both worked at the United Nations to ensure that this was not a party problem. Because there is so little time tonight, I shall ask noble Lords to concentrate not on all that we are thinking about and upon which we all agree but on how we are going to do something about it.

I have with me an advertisement for a clinic entitled, "Medical Treatments Without the Worries", which appeared in the Evening Standard after we had passed the legislation. It advertises surgery for women and men, and states that it is "registered with the local health authority". I wrote to the newspaper expressing the view that this was not how we ought to advertise such services. I received a very nice reply from a man at the Evening Standard who said that he did not know about the legislation and that he would try to ensure that such an advertisement was not put in the newspaper again.

I then wrote to the director of the Department of Environmental Services for the City of Westminster. He, too, said that he did not know about it. He wrote that, the premises are not licensed under the London Local Authorities Act 1991". He then went on: The premises do, however, appear to be carrying out 'special treatments'", and perhaps they should not have been.

I want to be practical tonight. We have all the theory and all the understanding necessary. We must try to establish among the press an understanding of the legislation. We must also impress upon local authorities that they are not carrying out the provisions of the legislation. I should like to ask my noble friend the Minister on the Front Bench how many such accusations have been made since we introduced the legislation. I believe that he will be surprised to find that he can tell us nothing in that respect.

We have an increasing number—and so we should have—of young girls in this country. We send out messages to teachers and to schools. Indeed, this week we set up a campaign to encourage young girls to have higher aspirations, and so on, but there is not a word in that about this subject. Indeed, many girls might be suffering from what we are discussing tonight. I must say that neither party has done anything realistic to bring into the publications of statistics the maternal deaths as a result of what is happening to smaller children. We have not done enough. We have not implemented the legislation that the noble Baroness, Lady Cox, and I brought through your Lordships' House a few years ago.

9.33 p.m.

Lord Dholakia

My Lords, I am grateful to the noble Baroness, Lady Gould, for initiating tonight's debate. If I do not thank each speaker for his or her excellent contributions tonight, that is simply because I am biding by the edict issued by the noble Baroness, Lady Amos. This is a subject which rightly causes revulsion in your Lordships' House because, as everyone has pointed out, it concerns the mutilation of a woman's body. It goes against the instinct of almost all men and women who subscribe to civilised values. It is right that we have the Prohibition of Female Circumcision Act 1985. Let us remind ourselves what it is all about. The Act makes it an offence to carry out this practice. It also makes it an offence for anyone to aid, abet, counsel or procure the carrying out of these procedures by any other person on her own body.

The question now is how effective this legislation has been. It is right that we should demand an answer. My noble friend Lady Thomas of Walliswood rightly spoke in the context of human rights. I wish to expand on that and talk about the rights of the child. When it comes to human rights there can be no compromise on practices that are harmful. I do not know of any religion which prescribes mutilation. That has been confirmed today. The practice which is prevalent in some countries inflicts mutilation on girls as young as four years old. UNICEF describes it as one of the worst violations of the Convention on the Rights of the Child. We rightly condemn such practices because they are unacceptable on scientific, moral or religious grounds.

We must always be vigilant to ensure that those who have chosen to be part of our multi-cultural, multi-ethnic and multi-religious society are aware of the law that is designed to protect victims. We should ensure that we use the full force of the law against perpetrators who perform such deeds in a misguided belief that they protect virginity, ensure marriageability and contain sexuality. The noble Lord, Lord Ahmed, referred to that matter.

All those who work with children, either in a voluntary or statutory capacity, are interested in achieving lasting benefits for children within the communities in which they live. We all want to make a reality of children's rights. It cannot be disputed that female genital mutilation causes unnecessary suffering to girls. It is a harmful practice and we are right to condemn it.

I said that I would speak in the context of the rights of the child. Every child has a right to a childhood. I refer to Article 2 of the convention, the right to equality irrespective of sex. Article 19.1 concerns freedom from all forms of mental and physical violence or maltreatment. Article 24.1 refers to the highest standards of health. Article 24.3 refers to taking effective and appropriate measures to abolish traditional practices prejudicial to the health of children. Article 37(a) refers to freedom from torture, cruel or inhuman or degrading treatment.

A number of questions need to be asked as to what progress has been made to eradicate this practice in the UK. Obviously I do not expect all the questions to be answered today. I hope that the noble Lord will study Hansard tomorrow and will reply in writing to some of the questions that cannot be answered today because of time constraints. However, I shall put the questions to him. How many criminal prosecutions have been carried out against the perpetrators of such practices? What guidelines have been issued to their members by health professional bodies on this subject? What programme of public education is undertaken for refugees who arrive here from certain countries where such practices are prevalent? Do we publish information in other languages so that refugees and others are aware of the law in the United Kingdom? Do we make use of consistent messages and all available channels to communicate information to the public?

What training and guidance are available to health professionals on the elimination of this practice? Is appropriate counselling provided for the rehabilitation and treatment of women and girls who suffer problems related to their mutilation? We must never forget the isolation suffered by some of these people within their own communities. What financial and other support is available for women's groups and advocacy groups? That matter was referred to by the noble Baroness, Lady Uddin. Such groups are important as they act as catalysts in starting open discussion where it is taboo to discuss such matters. Finally, do we target information at traditional healers and birth attendants who practise mutilations in the name of certain cultures?

Legislation alone is not enough. It can be effective when a system of child monitoring and protection is in operation, when there is widespread education of communities and motivation of public opinion against the practice; and when women and communities are involved in efforts to abolish this practice. We should not compromise for anything less.

9.40 p.m.

Lord McColl of Dulwich

My Lords, I too would like to thank the noble Baroness, Lady Gould of Potternewton, for bringing this subject to our attention this evening. As the noble Lord, Lord Rea, has said, the problem is that you can outlaw the practice but that may not work. For instance, in the Sudan it was banned in 1946 but it is still very widely practised. To be precise, 89 per cent. of women and girls in North Sudan have undergone this procedure. It is carried out by women for deeply felt beliefs which we need to understand.

As the noble Baroness, Lady Uddin, has mentioned, great credit goes to the London Black Women's Health Group for helping to eradicate this practice. But we need to remember that that group lobbied against the 1985 Act on the basis that they preferred to use education and support as tools to eliminate the practice. They feared that the Act would push FGM underground and would discourage victims from seeking medical advice.

As the noble Lord, Lord Ahmed, has pointed out, the history of FGM goes back to ancient Egypt. It may sound very curious, but it was thought that the external genitalia possessed a bi-sexual quality. Therefore both sexes had to be circumcised in order that their individual sexuality could develop. As has already been mentioned, some regarded it as essential for personal hygiene—which is rather strange because it frequently leads to all kinds of infections.

The basis for this practice is very much more complicated. In countries where FGM is prevalent, the great objective is for a girl to marry to maintain her class or status in life, and preferably to improve her status. She can only achieve this if she is a virgin. Her status, of course, involves the whole of the family. If she fails in this regard then she drags the whole family down, socially and financially.

Quite apart from the question of virginity, there are very serious consequences for girls who do not have FGM. It is the value of the bride price paid to the woman's family that dictates the need for FGM. I quote J. Smith from an international survey published in Amsterdam in 1995. He said: The more major the operation on the girl, the greater the dowry that is paid for her, in other words, her market value rises". A daughter without this procedure denies her family this precious resource. It means that she will be shunned from normal community life. I quote from Eliah in an article published in Populi in March 1996. She will be not allowed to enter the granary, milk the cows or even collect cow dung; at the well they must wait until all the other women have drawn water". Without FGM, the possibility of marriage and a dowry are grossly diminished, putting a great financial strain on her family.

To illustrate how entrenched this custom is, I should like to tell the House of a British doctor who was totally opposed to FGM who used to live in the Sudan with his Sudanese wife and two daughters. When he was abroad at a medical conference his two daughters were subjected to this procedure because of enormous female peer pressure. Understandably, he was devastated when he found out what had happened.

Opposed as we are to this practice, the vehemence of its denunciation has been resented by many women who have had FGM. We could not blame them for drawing our attention to the fact that the incidence of sexual abuse of children in this country is very much greater than the incidence of FGM. Western countries describing FGM as barbaric, uncivilised and painful is not helpful. That kind of soundbite creates hostility to those who are trying to eliminate it. We need more subtle and sympathetic techniques which emphasise the very serious health risks.

For instance, in those countries where FGM is widespread, local people put on short plays in villages illustrating the health dangers of FGM, how completely unnecessary it is and how children have a right to say no. I have seen some of these plays performed by the inmates of prisons in Uganda in an attempt to warn people of the dangers of HIV infection. The plays were professional, moving and, I believe, effective. In villages in Senegal the United Nations Children's Fund is financing this kind of activity. As a result, in Senegal 29 communities have declared an end to FGM. In the city of Bamako in West Africa a major success has been achieved in persuading 25 circumcisers to stop their work. In a public ceremony, the leader of the group put her stubby, blackened knife into a basket held by the wife of the country's leader. Perhaps their success was in part due to the fact that the local organisations found the circumcisers alternative work in small businesses and encouraged them to join local groups in spreading the message.

I shall be very interested to hear from Her Majesty's Government what they are doing to encourage the elimination of this practice throughout the European Union and, in particular, whether they are thinking of trying to prevent children being taken abroad for this procedure.

9.47 p.m.

Lord Hunt of Kings Heath

My Lords, I thank my noble friend Lady Gould for initiating the debate on female genital mutilation. I know that there are sensitivities in using that term rather than female circumcision. But in preferring FGM, I am taking my cue from the World Health Organisation in sending out a clear message that the practice is a violation of human rights. I should also like to acknowledge the contribution of the noble Baroness, Lady Masham, in taking the Female Circumcision Bill through the House in 1985 and also the contribution of my noble friend Lady Jeger.

As the noble Baroness, Lady Thomas, said, FGM is not an issue that is often or easily discussed, and yet if we are to make a real impact to eradicate this brutal practice—I do not shy from that description despite the words of the noble Lord, Lord McColl—it is something that more and more people should be aware of. My noble friends Lady Gould and Lady Rendell clearly and graphically underlined the horrors of the practice and the pain felt by so many girls and women.

FGM affects a significant proportion of the world's population and is practised by many different religions, including Christians, Moslems, Jews and non-believers. It is by no means a single religious issue and should not be portrayed as such. I found the remarks of my noble friend Lord Ahmed particularly valuable here. As the noble Lord, Lord Dholakia, said, the Prohibition of Female Circumcision Act makes it an offence to carry out female genital mutilation in any of its various forms. It also makes it an offence for anyone to aid, abet, counsel or procure the carrying out of these procedures by any other person.

Further legal protection is provided by the Children Act 1989. Under the Act a prohibited steps order can be made by a local authority to prevent parents carrying out an act without the consent of the court. This covers taking a child out of the country for mutilation to be carried out abroad. That was an issue, particularly highlighted by my noble friend Lady Rendell and my noble friend Lord Rea. The Government recently took the opportunity to change the law on conspiracy in the Criminal Justice (Terrorism and Conspiracy) Act 1998. It is now an offence for a person to conspire to commit an offence outside the UK provided the act constitutes an offence both under the law in the UK and under the law in the country in which the act is to be committed. Where the Attorney-General consents to the institution of proceedings, that enables courts in the UK to deal with conspiracies in this country to commit offences against children abroad, including conspiracies to take children abroad to carry out FGM on them.

In 1991 the Department of Health issued further guidance entitled Working Together Under the Children Act 1989. This set out information on the Children Act relevant to FGM and was issued to local authorities, health authorities, the police, the probation service, educational establishments, doctors and a range of voluntary organisations. This document is currently being updated and will be re-issued in the spring.

The noble Baroness, Lady Thomas, asked about international action as did the noble Lady, Lady Kinloss. The UK has further committed itself to the eventual eradication of this practice through ratifying the objectives laid down in a number of UN resolutions, including the UN Global Plan for Action and Beijing Declaration, 1995, as well as the United Nations Convention on the Elimination of All Forms of Discrimination Against Women. Indeed, the UK has recently co-sponsored a resolution on traditional or customary practices affecting the health of women and girls which reaffirms our commitment to this issue.

In having legislation in place which makes FGM illegal, the UK is ahead of many other countries. However, despite these measures it is known that FGM is still being carried out in various communities in this country.

Criticism was made by the noble Baroness, Lady Masham, my noble friend Lord Rea and my noble friend Lady Jeger in that to date there have been no prosecutions under the Act. There are a number of complex reasons for that. Not least is the fact that female genital mutilation is deeply steeped in the culture and tradition of those communities which perform it, as a number of noble Lords have said. That makes it immensely difficult to obtain sufficient evidence to enforce a conviction. Complaints of that nature are very rarely made to the police. Even where a complaint is made the same factors can make the investigation, and attempts to gather evidence, enormously difficult. The investigation of complaints should of course be undertaken in a way that is sensitive to the culture and traditions of those communities which practise FGM. I believe that my noble friend Lady Gould had much of importance to say about that.

That is not to say that the Act is unenforceable, neither is there any evidence to suggest that the police or prosecutors do not take this offence seriously or are reluctant to prosecute. However, it is for the police to decide whether there are sufficient grounds for criminal charges to be brought against the individual and to warrant a referral to the Crown Prosecution Service. That service is alive, as we all are, to the sensitive issues inherent in this category of case, not least because children may be involved. The fact that there have been no prosecutions is not because the CPS or the police are not enforcing it; nor is it because of a lack of clarity in the existing law. It is because of the difficulties in obtaining evidence to support prosecutions.

Baroness Jeger

My Lords, before the Minister sits down, can he explain what steps we are taking to implement the Act about which we are talking?

Lord Hunt of Kings Heath

My Lords, as I have explained, there is no lack of determination that the law, as it applies to this country, should be enacted. I am trying to describe the practical difficulties which the police face in enforcing this Act.

Baroness Nicholson of Winterbourne

My Lords, I am grateful to the Minister for giving way. I accept the practical difficulties in bringing criminal prosecutions in this sort of case. Nevertheless, all of us are aware that children are taken away from their parents on grave suspicion of reduction of their human rights on far less evidence and for far less dreadful activities than this. Can the Minister tell us why children are not removed from their families and put in care when there is a suspicion that these activities have been undertaken?

Lord Hunt of Kings Heath

My Lords, as I said earlier, this issue also falls under the provisions of the Children Act 1989. I have already said that under that Act a prohibited steps order can be made by a local authority to prevent parents carrying out an act without the consent of the court. However, just as in the case of action taken by the police, I believe that there are real difficulties in obtaining evidence to warrant that action.

I refer to two cases raised by my noble friend Lady Gould. In 1993 a GP was struck off the medical register for gross misconduct relating to FGM. The doctor was not prosecuted in that case because he did not perform an operation. He was contacted by an undercover journalist and agreed to perform an illegal operation. His agreement to perform the operation was regarded by the GMC as gross misconduct. However, as he did not perform it, his actions were not considered to be illegal.

I am also aware of the programme broadcast by Channel 4 last year on this subject. I understand that the South Yorkshire Police received a complaint against a man implicated in carrying out mutilations in that area. However, he had left the area before the police could interview him and he has not been traced since.

In terms of the support given by the Government to organisations engaged in important work in this area—a point about which my noble friend Lord Rea asked—I want to make it clear that the Department of Health is committed to continuing with and supporting these important groups. The department has developed close links with the Foundation for Women's Health Research and Development (FORWARD) which is the leading voluntary organisation in the UK that deals with FGM. I should like to pay tribute to the excellent work undertaken by that organisation.

Under section 64 of the general scheme of grants, FORWARD is currently receiving a core grant of £30,000 over three years to help to meet general running costs. In addition, it is receiving a project grant worth £22,500 for a three-year period to fund the production of a health education pack. This funding overall is secure until the year 2000. Further bids are now being considered.

In addition, a Department of Health official is currently on secondment to FORWARD for a minimum of two years to work as a national liaison officer. This will include local authority liaison with the objective of identifying the key elements of a "best practice" model to co-ordinate local authority health, education, social services and child protection activities.

Further funding has also been secured through the department for a health promotion officer, who will take up post shortly. This person's role will be to liaise with ethnic communities to produce health and education literature in a range of relevant languages; and to produce a training pack for health and education professionals.

Over the past few years, the Department of Health has provided funds totalling nearly £280,000 for projects developed by FORWARD in this country. Similarly, the Department for International Development has committed over £250,000 for two projects with which FORWARD is involved in Nigeria and The Gambia.

The issue of guidance by professional bodies was raised by a number of noble Lords. The Government welcome the production of guidance for practitioners by their professional bodies to help them to deal sensitively and effectively with FGM. I am pleased to say that my honourable friend Tessa Jowell will be launching the Royal College of Midwives' position paper on FGM on 18th November and I hope that all midwives will take the opportunity to increase their knowledge and understanding of this important issue, and use it to inform their practice.

I might also add that the department has also released funds to help to establish the north-west London African-Somalian Well Women Project being run at the Central Middlesex Hospital NHS Trust. The clinic aims to meet the particular cultural and medical needs of the local community in a humane and sensitive way. Raising understanding and awareness of the physical and psychological impact of FGM is considered to be vitally important. It is very much hoped that the unit will become a centre of excellence from which other practitioners and service providers can learn.

I have not been able to answer all the points that have been raised, but in conclusion may I say that this has been a very valuable debate which has brought to public attention the distressing effects of the brutal practice of FGM. My noble friend Lady Jeger asked: what is to be done? I do want to assure your Lordships that despite the lack of prosecutions under the Act the commitment of the Government to eradicating FGM should not be in doubt. As my noble friend Lord Rea and the noble Lord, Lord McColl of Dulwich, said, legislation by itself is not the answer. We therefore need to look to other means of influencing behaviour in our efforts to stamp out FGM in this country.

We are quite clear that relevant agencies need to remain alert to the communities in their population that might be carrying out such procedures and to protect those children they deem to be at risk. Support should be available to those who need it and the process of educating those communities which continue to practise FGM must and will continue. I very much hope that this debate will help to open the eyes of many people to these appalling practices and that by opening up the issues we shall have a much greater opportunity of combating this barbaric practice.