Saving Mothers' Lives: - Public Health Agency for Northern Ireland

double the number of cases in the last Report. There were an additional fi ve women who appeared to have
come to the UK to have NHS care for their pregnancy and childbirth. A further seven Black African women
died within a year of childbirth, the majority from Late Indirect causes.
Apart from the fi ve women who appeared to have come late in pregnancy expressly to have their baby in
the UK, who came mainly from Nigeria, the African countries with the greatest representation of women
were Somalia and Ethiopia, but a wide range of other countries were also represented including, for the
fi rst time, Francophone African countries.
Female Genital Cutting or Mutilation (FGC/M)
Although it is illegal to perform female circumcision, a procedure more commonly known as Female Genital
Cutting (FGC iv ) or Mutilation (FGC/M), in the UK it is likely that its prevalence amongst the pregnant population
is increasing 32 . This is largely due to inward migration from countries or cultures where it is still routine practice,
despite almost universal international condemnation at Government level. As well as being illegal to perform it
in the UK, it is also illegal to perform it in any other country on UK citizens or permanent residents.
Estimates of prevalence in England and Wales have been derived by analysing births in England and
Wales by the mother’s country of birth and applying estimates based on surveys to the prevalence of
FGC/M in the country of origin. The estimated percentages of all maternities in England and Wales which
were to women with FGC/M increased from 1.06 per cent in 2001 to 1.43 per cent in 2004. The latest
study showed considerable geographical variation. In some major cities and other conurbations with large
populations of Somali or Kenyan women, the estimated percentages of maternities affected by FGC/M had
already exceeded two per cent by 2004 28 .
FGC can affect women’s pregnancies in a number of ways 33 . This Report considered the deaths of at least
four women known to have been cut in this way, three of whom did not disclose their condition until very
late in pregnancy or in early labour. For one woman, her late disclosure may have directly contributed to
her death following an unnecessary caesarean section because staff were not aware that a corrective
procedure could have been performed during her antenatal period. For another, her condition was not
apparent until she was fi rst examined in established labour yet the obstetrician was not informed until her
labour stalled some hours later. There are a growing number and variety of educational materials and
sources of help available for both health professionals and women themselves.
In response to the increasing prevalence of women living with FGC/M in the UK, there are an increasing
number of midwives and obstetricians and specialist services able to advise, help and support pregnant
women living with FGC/M. As a result, women from counties where this is likely to be practiced should be
sensitively asked about this during pregnancy and management plans agreed during the antenatal period.
iv Women who have been cut generally do not like the term mutilation and prefer to the practice as genital cutting.
Other migrant women
Although Black African women formed the majority of recently arrived women who died from maternal
causes, there were also increases in, or lessons to be learnt from, other groups of new migrants.
Women who contract to marry UK men
Previous Reports have commented on how some women who contract to marry UK men in order to build a
better life for themselves, who are sometimes demeaningly referred to as “mail order” brides, died because
they were not helped by their husbands to seek the care they needed once pregnant. Language diffi culties
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