The Tennessee Department of Health’s (TDH) Mission Statement is to:
[p]rotect, promote and improve the health and prosperity of people in Tennessee….Protecting people’s health by preventing problems that contribute to illness, disease and injury is the overall emphasis of the department.
As a matter of public health, however, it appears that the TDH does not consider that eradicating female genital mutilation (FGM) is part of their mission.
A search of the TDH website and the wide variety of resources including reporting and training shows not a single reference or resource to FGM, even as an “adverse childhood experience.” Despite the estimated high risk to women and girls in Tennessee from FGM the TN Department of Health has elected not to address the threat as part of its mission.
After learning about the twenty-one cases of FGM in Tennessee in 2011, The Tennessee Star asked the TDH whether any of those cases had been reported to any of the local or regional health departments and whether TDH was aware of any other incidents of FGM occurring after 2011.
Without any additional comment, TDH responded by quoting back the 2012 FGM reporting law and underscoring the law’s mandate that law enforcement has an affirmative duty to receive and report when girls under age 18 are mutilated in Tennessee.
TDH did not answer a follow-up question regarding whether the law prohibited TDH from collecting FGM incident information. TDH did, however, confirm that they had not asked any legislator to add TDH to the reporting statute.
Sen. Bill Ketron, the sponsor of the 2012 FGM reporting law told The Star that the initial goal of his bill was to put the issue of FGM, which he describes as “a despicable act of abuse,” in the hands of law enforcement for prosecution. As to reporting FGM cases to the TDH, Sen. Ketron said, “I also think that it would be helpful to keep track of this through the Department of Health and will bring a bill next year to accomplish this.”
With federal and state laws prohibiting FGM, there is good reason to believe that the mutilation of young girls has gone underground, as evidenced by the recent case of the Detroit doctor arrested for allegedly performing FGM on two young girls brought to her from Minnesota. The FBI’s investigation so far has found that other young girls from Michigan were also victimized by this doctor.
The Center for Disease Control estimates that the risk has tripled since 1990, and the Population Reference Bureau (PRB) estimates rank Tennessee 18th in the country for risk to women and girls from FGM. The dramatic increase in risk is attributed to immigrants, including refugees, who come to the U.S. from high FGM prevalence countries.
Federal contractors in Tennessee have been resettling refugees from countries including Somalia, Ethiopia, Eritrea, Liberia, Nigeria and Sudan, listed in the Population Reference Bureau (PRB) report as among the “Top 10 Countries of Origin” where FGM is practiced.
The 2014 Office of Refugee Resettlement 2014 Annual Survey of Refugees documents that of the refugees that have been in the U.S. for five years, forty-four percent are either enrolled in a state Medicaid program or receiving publicly funded refugee medical assistance.
Local and regional public health departments provide a variety of services including “Child Health” serving children birth to 21 which can include physical exams, “Family Planning” which can also include a full physical exam, and “Prenatal.”
Services at the public health departments can be paid for based on an income sliding scale or with insurance, including TennCare, the state’s Medicaid program, making the public health departments a logical agency for reporting suspected or discovered cases of FGM.