Twelve years after being made illegal, the UK’s first female genital mutilation (FGM) trial is under way with the suspects appearing in court yesterday. Dr Dhanuson Dharmasena stands accused of carrying out FGM at a London hospital after the delivery of a baby to a young woman of Somali origin, whilst Hasan Mohammed stands accused of encouraging him. Both men deny the charges.
Dr Dharmasena qualified as a doctor in 2005 and began specialising in obstetrics and gynaecology in 2008, the Guardian has reported. He had been working at the Whittington hospital in London for one month when the events occurred in 2012.
His patient was a 24 year old first time mother who had undergone type 3 FGM, which involves sewing the labia together, as a six year old child in Somalia. Dr Dharmasena made two cuts to her vaginal opening to ensure safe delivery of the child, but following the birth sewed her back up.
“It is the stitching back together by Dr Dharmasena which the prosecution says is an offence under the act,” Kate Bex, prosecuting, told Southwark crown court. A midwife warned him that the stitch he made was illegal, but when he asked a senior consultant for advice, was told it would be “painful and humiliating” for the stitch to be removed, and so he left it in place.
Under current British law a doctor has not committed an offence if he surgically operates on a woman in any stage of labour, or following a birth, if the action is connected with the birth or labour. Bex told the jury: “It will be for you to decide if Dr Dharmasena’s admitted act of sewing [her] labia together was necessary for her physical health or was for purposes connected with the labour or birth,” adding “a woman’s labia should not be sewn together at all unless medically necessary.”
During the trial it emerged that the woman had been seen by midwives during antenatal appointments at the hospital. Although she had been asked standard questions on whether she had been subjected to FGM, she told the midwife “it’s fine, it’s opened”, referring to a revision of her circumcision which had taken place in 2011.
However, the midwife ought to have organised a birth plan which included deinfibulation – the reopening of the vagina – well in advance of labour. She did not. Instead, the woman’s circumcision was not discovered until she presented at the hospital at 8.55am already in labour.
Dharmasena arrived at the delivery room at 10.10am and found the birth progressing quickly. He made two cuts to facilitate the birth, including a cut through scar tissue caused by the FGM. Following the birth half an hour later, a senior house officer stitched up the mother’s wounds caused by the birth.
However, at the behest of Mohamed, Dharmasena then sewed up the labia with one continuous stitch of around 1.5cm – 2 cm long, the Crown said. It was this stitch that midwife Aimma Ali in private advised Dharmasena was illegal. He sought advice from the on-call consultant Vibha Ruparelia explaining that he didn’t know it was illegal, but was told that removing the stitch would be too painful and humiliating, so it was left in.
In his notes, Dharmasena wrote “Had discussion with consultant post delivery. In hindsight should not have closed stitches. Decision made not to reopen sutures.”
Bex said that his actions were against hospital policy, which Dharmasena was expected to be aware of. “The … published policy is that the cut edges should not be stitched back together and that they should be over-sewn with absorbable stitches so that they heal apart,” she said.
During an internal hospital investigation, Dharmasena made a statement saying “I was not entirely sure how to repair the anterior midline incision. The cut edges were very small containing scar tissue and had minimal bleeding.”
However, the prosecution says that when arrested in August 2013 he changed his defence, justifying the stitch on medical terms, writing “A single suture was appropriate … in an FGM case where there is bleeding.” The case continues.
During the trial Bex admitted that the case was not what might commonly be thought of for an FGM prosecution. She told the jury “If you do know a little about FGM you may be expecting to hear that the offence took place in a back-street clinic by an unqualified and uncaring person on a young child. This trial is quite different but it nevertheless involves FGM.”
According to the NHS, 20,000 girls under the age of 15 are thought to be at risk of FGM every year, and at least 60,000 women are thought to be living with the consequences of FGM. But despite the practice being outlawed under the Female Genital Mutilation Act 2003, no-one has ever been prosecuted for it.
Many girls are taken abroad so that wounds can heal during the summer holidays, but this too is illegal. Others have the act performed in the UK, behind closed doors. The circumcision is most commonly done without anaesthetic, using knives, scissors, scalpels, glass fragments or razor blades.
It has no positive health benefits, but many negative ones including risk of shock or infection which may lead to death and injury to other organs nearby, and in the longer term, kidney damage or failure, infertility, complications in pregnancy including new born death, and pain during sex.
Around 130million women are thought to have suffered FGM worldwide, the vast majority in Africa, but there is evidence that it may be underreported in the middle east, where Salafi Muslims believe it to have beneficial outcomes.
The Islam Question and Answer website, founded by Shaykh Muhammad Saalih al-Munajjid, who, according to al-Jazeera, is one of the most respected Salafist scholars, says that “circumcision is obligatory for males and that it is one of the symbols of Islam, and that circumcision of women is mustahabb but not obligatory.”
It quotes a female gynaecologist, Sitt al-Banaat Khaalid, as saying “For us in the Muslim world female circumcision is, above all else, obedience to Islam, which means acting in accordance with the fitrah and following the Sunnah which encourages it. We all know the dimensions of Islam, and that everything in it must be good in all aspects, including health aspects.If the benefits are not apparent now, they will become known in the future, as has happened with regard to male circumcision – the world now knows its benefits and it has become widespread among all nations despite the opposition of some groups.”
The supposed “health benefits” of female circumcision, according to the site, include “reducing excessive sexual desire”, reducing the sensitivity and arousal of the clitoris “which is very annoying to the husband”, and preventing “spasms of the clitoris [presumably orgasms] which are a kind of inflammation”.