Áine Brady (Kildare North, Fianna Fail)

): I thank Senator Bacik for raising this important issue and I am pleased to have this opportunity to respond on behalf of the Government. The Department of Health and Children is working to develop a legal framework that will explicitly prohibit the practice of female genital mutilation.

FGM is a harmful tradition and practice and a form of violence that directly infringes women's and children's rights to physical, psychological and social health. The World Health Organisation defines FGM as any procedure involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. The WHO estimates that between 100 million and 140 million girls and women worldwide have been subjected to some form of FGM and a further 3 million girls are at risk each year. This equates to 6,000 women and girls undergoing FGM daily around the world. Prevalence, type and the age at which FGM is performed vary between and within countries and regions, with ethnicity being the most decisive factor.

Increased immigration to Europe has meant that a cultural practice previously associated with the developing world has become a problem that needs to be overcome in a culturally sensitive manner in European societies, including Ireland. In many cases families and communities will attempt to practise FGM after moving to Europe as a way of upholding traditional customs. Despite legislative efforts by many countries to stop this practice, several studies have indicated that many girls living in Europe remain at risk from FGM.

The rationale for the continuance of FGM varies across regions, countries and cultures, but in every society in which it is practised it is an expression of gender inequality. In many instances, parents want their daughters to undergo FGM to avoid stigmatisation or social exclusion by the rest of the community. In practising communities, it is strongly believed a girl is not marriageable if she has not undergone FGM.

The practice has no health benefits. It involves removing or damaging healthy and normal tissue and interferes with the natural function of girls' and women's bodies. Immediate health consequences of FGM can include severe pain, shock, haemorrhage, difficulty passing urine, infection, psychological trauma and sepsis, and it can lead to death. Long-term complications include chronic urinary and menstrual problems, chronic pain, pelvic inflammatory disease, cysts, infection, increased risk of HIV transmission and infertility. FGM also has serious and adverse consequences for mothers and children during childbirth. A WHO study found significant associations between FGM and various types of obstetric complications. The risk to women's and girls' health is invariably aggravated by the use of septic equipment, unsanitary environments, lack of anaesthetic and the procedure being carried out by unskilled members of the community. In addition to physical health consequences, women who have undergone FGM also report negative psychological and emotional effects. The trauma for some women subjected to FGM can be reactivated in situations that bring back memories of the mutilation, such as childbirth and vaginal examinations.

Extensive work has taken place on FGM over recent years in Ireland. The relevant Departments and statutory agencies have been supporting the national action plan to address FGM in Ireland, which was launched in 2008 by the national steering committee on FGM. This committee comprised both governmental and non-governmental organisations, including the HSE, the former Women's Health Council and Irish Aid. The HSE has been playing a key role in the prevention of FGM and the delivery of care to women who have already undergone the practice. The health needs of women who undergo FGM have been acknowledged in the HSE intercultural health strategy 2007-12 and the principles and recommendations of the strategy align closely with the objective of the national action plan to address FGM. The HSE was represented on the steering committee that developed the plan and continues to support the ongoing work of the group established to progress its implementation. In this regard and in line with the principles of the intercultural health strategy on partnership working and cross-sectoral collaboration, the HSE national social inclusion unit has made funding available to AkiDwA from March 2009 for progressing the health related objectives of the national action plan for FGM. These aim to provide high quality and appropriate health care and support for women and girls who have undergone FGM.

The HSE's initial work has prioritised those aspects of awareness raising and provision of information to health professionals as identified in the action plan. Outcomes thus far include the development of professional supports for those involved with providing care for women and girls who have undergone FGM; the development and dissemination of information for health care professionals working in Ireland; the delivery of training sessions to up to 500 health professionals working in relevant service provision areas, including midwives, general practitioners, public health nurses and social workers; working towards the integration of routine FGM questions and examinations as part of antenatal care; and agreement with CervicalCheck that appropriate training in cervical smear taking and FGM will be integrated into ongoing training modules around cervical screening. The HSE is continuing to fund AkiDwA to progress these objectives. The HSE has stated that while initial work in the area of FGM in Ireland has focused on addressing health and care needs of women who have undergone this procedure, it is now incorporating prevention and awareness raising into its initiatives.

Another statutory member of the national steering committee was the former Women's Health Council. In June 2008, the council published a literature review on the health implications of FGM and made recommendations on its prevention, the care needs of women affected by it and the necessary legal framework. As the Senators might be aware, the Women's Health Council was subsumed into my Department last October and we now have the benefit of its knowledge and expertise in this area to guide us in our policy review.

Irish Aid has long recognised the detrimental effects of FGM and has contributed financially and programmatically to strategies targeted at community abandonment of FGM in developing countries. In 2008, Irish Aid contributed to the joint UNICEF-UNFPA fund to end FGM.

The Department of Health and Children has taken a number of steps to raise the awareness of health professionals on this matter. Officials wrote to the then health boards in 2001, again in 2004, and to the HSE in 2007 drawing their attention to the issue of female genital mutilation and requesting that personnel working with immigrant populations take opportunities to educate them about the dangers and unacceptability of FGM. Moreover, the Department wrote to the HSE again in 2009 following the launch of the national action plan on progressing the health actions included in it.

The Department also wrote to the Department of Justice, Equality and Law Reform in 2004 and 2007 about the issue. It asked that staff under the aegis of that Department whose work brings them into contact with persons from regions where female genital mutilation is practised should be made aware of the issue and should educate and inform such communities about the illegality and unacceptability of FGM. The Minister for Health and Children, Deputy Harney, met representatives of the national steering committee for the national action plan on 21 July 2009 and promised to seek further legal advice on the issue.

It is believed that FGM would constitute an offence under the Non-Fatal Offences against the Person Act 1997. The mutilations which are typically performed during acts of FGM would probably meet the definition of "serious harm" contained in the Act. It is likely, therefore, that for a person to perform an act of FGM would comprise an intentional act which causes serious harm and would thus be an offence under section 4 of the Act. The consent of a parent would not be a defence under section 4. In the event that in particular circumstances an act of FGM was found not to have resulted in serious harm, it would still be open to the Garda to prosecute for the similar, though less serious, offence provided for by section 3 of the Act which criminalises a person who "assaults another causing him or her harm". Notwithstanding this situation, from a legal viewpoint a specific offence prohibiting FGM would bring clarity and certainty to this issue, and it is in this context that my Department has been reviewing the legal situation with a view to progressing the drafting of policy proposals for a specific legal framework on FGM.

I thank Senator Bacik, once again, for raising this important issue. Female genital mutilation is an abhorrent practice which is unacceptable in our society. As one can see, there is cross-party and Department of Health and Children agreement with the main sentiment of Senator Bacik's Bill. In saying that, there are some issues which we believe are not included, such as definitions of the approved person to include midwives and trainee doctors, and the inclusion of an offence of aiding, abetting, procuring or inciting a person to commit FGM. Another is a more explicit prohibition of a cultural defence. We also need some time to explore the criminal justice, child protection and travel and immigration issues. There will be consultation with relevant stakeholders which will be an integral part in the development of any legal framework governing the prohibition of FGM. Expertise in gynaecological and obstetric care, child protection measures and criminal proceedings will be paramount in this work. All of these issues need to be tackled in a culturally sensitive way if we are not to alienate the very people we are trying to reach and protect from this practice.

I confirm that the heads of a Bill are to be published before the summer recess and the Minister, Deputy Harney, is agreeable to having the amendment amended to delete the words "this day 12 months" and substitute "this day six months", and this is being followed up.