Metro Nashville school nurses have not received formal training on how to spot potential cases of female genital mutilation despite state lawmakers drawing attention to FGM with legislation in 2012.
The 2012 law requires health care providers to report injuries related to FGM, a brutal practice in parts of Africa, the Middle East and Asia that has been brought into the West through immigration. In the U.S., Tennessee is ranked 18th in state rankings for potential risk for women and girls, according to the Population Reference Bureau.
The Tennessee Star has found that state and local agencies have not established clear guidelines and procedures for building awareness and documenting FGM cases to comply with the spirit and intent of the 2012 reporting law, which was passed to support state legislation in 1996 making FGM performed on a minor a felony.
School nurses in Metro Nashville Public Schools are required to take an annual training course on reporting child abuse but it makes no mention of FGM. The Metro Nashville school district has refugee and immigrant students from Somalia and other parts of the world where FGM is practiced.
“The annual course does not cover FGM specifically,” said Brian Todd, a spokesman for the Metro Public Health Department, which provides school nursing services. “It covers reporting child abuse on a broader scope.”
Todd emphasized that school nurses do not conduct exams that would verify FGM but said that “our nurses are available if a problem related to this is brought to their attention and would report such cases to the proper authorities.” The school nurse program includes 59 school nurses, 13 substitute nurses and five nursing supervisors.
The child abuse training video viewed by school nurses tells them that “you do not have to have proof that child abuse/neglect has occurred in order to report. The law speaks to making reports based on ‘available information’ and in a situation that ‘reasonably appears to have been caused by brutality, abuse, neglect, or sexual abuse.’” The video also says that failure to report child abuse is a misdemeanor that can lead to a fine of up to $2,500. The 2012 FGM law similarly made it a misdemeanor for failing to report cases to local law enforcement.
In Britain, where problems with FGM are more widespread because of higher levels of immigration, authorities have proactively asked school nurses to be on the lookout for signs of potential cases. School and community children’s nurses (CCNs) are given ways to recognize FGM and support girls and families, according to a 2015 article in a British publication for nurses called Independent Nurse.
“School nurses and CCNs are often in a position of trust and girls might confide in them, indicating that the child is at risk,” the article said. In addition, the report noted that these nurses “can be aware of behavioral change in young girls such as prolonged visits to the toilet.”
Improved awareness and reporting measures across the board have led to the public in Britain being better informed about FGM. The problem has become so acute that FGM is either discovered or treated at a medical appointment in England every hour.
At the time Tennessee lawmakers were working on passage of the 2012 reporting law, it was noted on the website for the Tennessee Senate Republican Caucus that there were 21 cases of FGM reported in Tennessee hospitals in 2011. There were no other details, such as the location of the hospitals or whether the FGM was determined to have been performed in the U.S. or abroad.
Under Gov. Haslam, the Tennessee Department of Health has not required health care providers to report cases to the TDH, nor does it mention FGM in its resources. State Sen. Bill Ketron (R-Murfreesboro), who sponsored the 2012 legislation, told The Star recently that he would bring a bill next year to require the TDH to keep track of cases.
Meanwhile, the Tennessee Bureau of Investigation does not have a subcategory for FGM under aggravated assault in its annual crime report.
A spokeswoman for the district attorney in Nashville told The Star that the district attorney’s office has not heard of any reports of FGM. “Nor do we have any reason to believe there might be a failure to report to law enforcement,” said spokeswoman Dorinda Carter. “These cases would be reported to police first and then referred to us for prosecution, but we have not received any cases.”
A Detroit doctor is currently facing federal charges for practicing FGM on young girls in keeping with the traditions of the Indian-Muslim group to which she belongs. A second doctor and his wife were arrested Friday in the widening case.