Identifying the Impacts of FGM

3.1 FGM & Trauma

Forms of trauma

Victims/survivors of harmful practices can experience varying forms of trauma, such as:

Health and medical trauma: psychological and physiological responses to pain, serious illness, medical procedures or invasive treatment experiences.

Relational trauma: the effects of experiencing abuse, abandonment, neglect or harm at the hands of a significant other normally a parent/carer.

Inter-generational trauma: the trauma an individual experiences is transmitted over generations so that family members who have not experienced the trauma can indirectly experience the effects of it.

Cultural trauma: when a cultural group has experienced events resulting in a deleterious impact on their collective consciousness, changing their sense of self in significant irrevocable ways.

Community trauma: communities that experience high levels of violence could experience trauma across a population . It could be in the form of physical or sexual assaults and threats.

Developmental trauma: events that occur at a specific developmental stage which goes on to affect later development, physical or mental health, and are often linked to adverse childhood experiences or can result from experiences not linked to a life stage.

Post-traumatic stress disorder: post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events. A person can develop PTSD immediately after experiencing a disturbing event, or it can occur weeks, months or years later.

Complex traumatic stress: psychological distress caused from an invasive, repeated and prolonged exposure to social and interpersonal trauma with loss of control and in a context where a person feels trapped.

Victims/survivors of FGM and other harmful practices may experience several forms of violence throughout their life course - we call this 'poly-victimisation'. For example, one girl may experience FGM, breast flattening, early forced marriage, leading to exposure to domestic or other types of abuse.

Remember that trauma can be a single or prolonged event; and that FGM is not always necessarily a one-off event. A girl or woman could be cut, uncut and then cut again following pregnancy. Labia elongation, the painful process of pulling and stretching the labia until it is elongated also occures as a prolonged event.

Seeing FGM from a girl or woman's perspective - common feelings and beliefs or girls and women:

• Fear they will be judged
• Believe openly discussing FGM is taboo (associations to witchcraft related beliefs)
• Feel FGM is private, since it pertains to an intimate body part, and that discussing it is embarrassing
• Experiencing mental health, limiting her open communication
• Fear of any professional in a position of authority
• Experience health consequences as a result of FGM

The above mentioned issues may limit a girl or woman seeking physical or psychological help.

3.2 A Trauma-Informed Approach to FGM

What is a trauma-informed approach?

Trauma-informed practice is an approach which considers the impact of trauma on an individual’s life. Delivering trauma-informed services includes understanding that the service users you are working with may have experienced or been exposed to trauma in their past. A professional must understand that such experiences of an individual impact the way a service user interacts with professionals, including their ability to feel safe, and feel open to talk with them.

A trauma informed approach includes:

Understanding trauma responses to prevent misinterpreting behaviours and the labelling of individuals

Recognising the signs/symptoms of trauma

Acknowledging the impact of an individuals traumatic experiences

Actively seeking to avoid re-traumatisation

Integrating an understanding of trauma into one's organisational policy and practice

Top tips for developing a trauma informed approach to FGM

• Use a non-judgemental approach
• Ask open ended questions in a professionally curious manner
• Don't assume anything of a girl or woman's experiences
• Show signs that you are actively listening to a girl or woman - for example by asking follow up questions
• Consider your language. Girls and women who have experienced violence may identify in different ways, depending on where on their journey they are, and thus ‘victim/survivor’ terminology acknowledges this. Asking girls and women about their experiences and the language they prefer reduces bias.
• Use effective communication skills - oral, written, non-verbal and most importantly listening
• Don’t make individuals feel shamed
• Don't show strong emotion to disclosures of a girl or woman’s experiences. For example, showing shock, gasps, shaking the head in disapproval etc.
• Acknowledge the girl or woman's experiences
• Reassure the girl or woman that their experiences are not their fault
• Bring to the forefront positive feedback - girls and women are more than the trauma they have endured
• Keep eye contact when a girl or woman is sharing her experiences
• Don't use victim blaming/shaming language
• Create a safe and trusting environment for survivors
• Be mindful of your tone of voice i.e. try not too be too loud, or too quiet

Develop a culturally literate response

When engaging with individuals, be aware the following:

• Showing images could be triggers
• Head movement, encouraging prompts
• Try not to interrupt
• Ask questions to clarify
• Occasionally restate a part of the story in your own words to make sure you understand
• Establish sequence

Welcome to your short assessment for module 3! Watch this short animation which pertains to a health visitor and mum, Mariam:

Test yourself based on the case study:

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