LONDON, UK — When a young doctor delivered a baby in a north London public hospital in 2012, he couldn’t have known the procedure would sweep him into a national controversy.
His patient was bleeding after the birth and needed stitches. Like tens of thousands of women in the UK, she had also been subjected to female genital mutilation, or FGM, years earlier.
Now the doctor, 31-year-old Dhanoun Dharmasena, is set to appear before a London court next week on charges that he committed the same crime himself.
A man believed to be a relative of the patient will also stand trial, accused of encouraging and abetting FGM. Dharmasena and Hasan Mohamed, 40, will be the first to be prosecuted for FGM in Britain 29 years after the act was criminalized here.
Exactly what happened in the hospital room has yet to be publicly revealed. But the case has prompted a clash between campaigners who say the prosecution represents an important step toward eliminating the crime against British girls and doctors who claim that political pressure has swept up one of their own at a cost to women’s health.
Female genital mutilation is the cutting or removal of women’s genitals for cultural, non-medical reasons. In the most extreme cases, a girl’s entire labia and clitoris are sliced off.
The UN classifies FGM as a form of torture. Girls who survive the procedure are at risk of infection, infertility and lifelong medical complications.
An estimated 125 million women around the world have undergone FGM. Thanks to immigration, it’s no longer confined to communities in sub-Saharan Africa and the Middle East.
An estimated 66,000 women living in the UK have been mutilated, according to a widely-cited 2007 report from the women’s rights charity Forward that provides the most current estimate.
The same report estimated another 23,000 girls under the age of 15 in Britain are at risk of being subjected to the procedure either in the UK or, more commonly, while visiting family abroad.
FGM was criminalized in the UK in 1985. In 2004, it became illegal to take a girl or woman abroad for the surgery.
But so far no one has been prosecuted for the crime.
Many cases have reached the state prosecutor’s office in recent years — including one against a man who called an FGM helpline seeking someone to cut his two daughters — but weren’t brought forward for lack of evidence.
Proving the abuse is exceptionally hard, lawyers and campaigners say, especially because young victims must testify against parents or other family members.
“If you wait for the archetypal young girl to come through the door to tell you about what’s just happened to her, what her family has put her through, that’s not going to happen,” Director of Public Prosecutions Alison Saunders told a parliamentary committee last month.
Britain's record on FGM is often unfavorably compared to that of France, which has prosecuted more than 100 people for the crime in the last few decades, far more than any other European country.
Evidence in those trials has sometimes come from regular medical examinations of girls believed to be at risk, something most British campaigners have been loathe to support.
However, the authorities have recently begun taking action.
In November, a joint task force of health and social service agencies released a report on ways to better identify girls at risk of FGM and report them to the authorities like other crime victims.
Parliament launched an inquiry into the Crown Prosecution Service’s failure to bring an FGM prosecution in December.
Saunders announced the case against Dharmesena and Mohamed in March, four days before she was called to testify before the committee.
Campaigners applauded the move.
“Whatever the outcome, this prosecution sends out a strong message that FGM is illegal and will not be tolerated,” says Efua Dorkenoo, senior FGM advisor for the women’s rights organization Equality Now, who called the prosecution “great news.”
But the charge against Dharmesena has been criticized by some British obstetricians, gynecologists and midwives, many of whom have also been active in efforts to stop FGM here.
“There’s clearly a world of difference between committing the crime of … slicing off part or all of a girl’s genitalia and causing major trauma, and what goes on in a labor ward,” says Edgar Dorman, an obstetrician and gynecologist at London’s Homerton University Hospital who works with patients who have had FGM.
“It’s distracting from the real issue of trying to prevent girls and young women from the risk of being mutilated.”
Homerton’s maternity ward treats several women a month who have undergone FGM in the past. Staff are trained to deal with the needs of such patients, who often require surgery prior to delivery.
If doctors and nurses are working under the fear of litigation, Dorman says, they could hesitate to offer necessary intervention to stop bleeding and save a patient’s life.
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The Crown Prosecution Service says Dharmesena committed FGM in the course of repairing the vulva of a woman who had previously been mutilated.
A woman who has had all of her external genitalia removed usually must be cut open to vaginally deliver a baby. World Health Organization guidelines say it’s “unethical” for a doctor to intentionally repair a woman’s vulva after birth in a way that would make sex or future childbirth difficult.
“If a family member is saying, ‘Please can you sew her up as she was before?’ the answer is 'Definitely not,'” he says.
But he adds that any wrongdoing on Dharmesena’s part wasn’t a criminal offense but the result of lack of training.
“He didn’t know what to put back together in what way.”