Call the Midwife sends out a poignant message – Hilary Garratt

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NHS England’s Director of Nursing and Midwifery explains why a TV drama’s powerful storyline helps support the modern day stand against Female Genital Mutilation:

Portraying social history through drama often helps me reflect on how much progress we have made to develop our laws and practices that support modern day societal views on issues, once rarely talked about or seen, but  now unacceptable.

Take this week’s episode of Call the Midwife with a storyline about a Somalian woman who had suffered Female Genital Mutilation (FGM).

Set in 1962 in inner city London, we saw health professionals in discussion and some confusion about what the Somalian woman needed by way of support and care. There was no mention of the condition being referred to as an act of mutilating violence. In those days it had no name and, furthermore, it wasn’t illegal.

Having spent time in a country where FGM is practiced, the issues raised were chillingly familiar to me.

I have known children who cannot be protected from the genital mutilation that awaits them in future years, and mothers whose resigned fear is the inability to protect their daughters from the same mutilation they, too, have suffered.

It’s all too difficult to talk about for them, and for me, as this is the norm of the land. I know how inability to protect brings a sense of powerlessness, something I felt myself when working among some of the most humble and generous females that one could ever wish to meet.

Here, in the UK, in 2017, FGM is illegal. It is abuse, extremely harmful, unnecessary, and can be stopped.

Unlike some other countries, we are fortunate in that we know how to care and support survivors, as well as put in place measures to protect young girls from FGM.

I feel privileged to have a role in NHS England that enables me to support programmes of work that develop understanding and targeted practice that address and support staff, victims and girls who are vulnerable to FGM.

I have met many nurses and midwives who are leading change and adding value to women’s and young girls’ lives and to the modern day evidence based practice of our professions. I have seen clinicians who create safe environments for sensitive discussions so best practice can then be deployed consistently to manage the issues associated with something that was once hidden and difficult to address.

Building an environment of trust with someone is what nurses and midwives do so well. This week’s episode reminds us of this with midwives who were non-judgmental, creating a safe space even though they found themselves in a situation that they found unusual.

Our nurses and midwives have been key to helping raise awareness of FGM and developing effective practice in this country in recent years. FGM has been a specific work stream within NHS England’s safeguarding programme for more than three years.

We have worked with our partners to ensure the NHS plays a vital role in supporting the eradication of FGM from our country. We have ensured that FGM is part of all safeguarding training so that clinicians understand their responsibilities in relation to national data reporting and more recently, the statutory duty to report FGM as a crime.

In 2017 we will continue our work with a specific focus on primary care, working with our national network of named GPs and the Royal College of GPs, to ensure we do more to support primary care staff as we extend our national data collection right across the NHS.

I have also been extremely fortunate to meet women survivors of FGM, some of whom work globally, across generations and cultures to prevent what happened to them from happening to others.

It inspires me to see what can be achieved and learnt from the generosity of people who have built expertise through experience and it’s always at its best when professionals and users learn together and deploy this through what then becomes best practice in the care setting.

For example, women survivors, nurses and midwives have told me its best practice for clinicians to  use terminology to explore FGM that is recognised and more comfortable for people presenting or at risk of FGM. It is often better to ask if a woman has been ‘cut’ or ‘circumcised’ rather than having had FGM.

We also know that using terminology that is culture specific helps to build the trust and confidence required to have a productive conversation which leads to a plan of support and care that includes ensuring the woman or child understands that FGM is illegal.

When nurses and midwives use their special skills to ensure victims know it is a crime in the UK, and that no woman or child should be mutilated, this is the opportunity do everything possible to protect not only other family members but also future generations.

Call the Midwife reminds us how FGM started to come into the consciousness of nurses and midwives and how. We have come such a long way in 50 years. Not only in our understanding of FGM, but in the development of our professional practice that requires every ounce of our finely tuned skills of care, compassion, commitment, courage, communication and competence; our professional values that enable  us to lead change, add value and  measure  success.

Throughout this year, on our safeguarding website, we will be featuring some of the services that do just this along with stories from users and survivors of FGM.

Meanwhile, I would like to pay tribute to victims, survivors, nurses and midwives; past and present, who have contributed to ensuring that we now have the legal protection and the access to professional care for victims of  FGM that were just not available in the 1960s. Legal protection works best when people work together and we will continue to develop our FGM programme so the NHS can continue to do more to protect young girls and women from harmful mutilation both in this country and across the world.


Image of Hilary Garratt​​​​​​​​​​​​​​Hilary Garratt​ is the Director of Nursing and Midwifery Team and is responsible for leading the team​ to deliver its corporate and directorate priorities throughout the year.

In January 2016 she was appointed as Deputy Chief Nursing Officer for England and will be supporting Jane Cummings the Chief Nursing Officer for England.

Hilary is a registered Nurse and Health Visitor with over 30 years’ experience of working in the NHS. Having gained a Bachelor’s and Master’s degree in health related subjects, for the last 3 years she has been working at a National Level as a Director of Nursing for NHS England.  ​

Hilary also volunteers for BBC Children in Need and is a committee member that undertakes grant making for the North of England.   A mother of three, she is also a trustee of a charity, “Giving to Gambia” and enjoys working in the Gambia for a short time each year as a volunteer to support initiatives that improve health and wellbeing.

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