In March UCL Medical School featured on BBC news as we are training future doctors to recognise the signs of forced marriage as part of the core curriculum. The NICE (National Institute for Health and Care Excellence, 2014) guidelines for domestic violence recommend that healthcare needs to do more in terms of domestic violence and improve learning to address issues such as forced marriage too. At UCLMS we feel it is important to tackle this.
The year started with a lecture to all Year 5 Medical Students on gender-based violence which included forced marriage. Since then as part of the Women’s Health and Men’s Health Module there have been monthly seminars that raise awareness of forced marriage and encourage dialogue on this difficult and misunderstood practice. Students get to learn about how to recognise the signs of forced marriage, how to address this with a patient and how to support someone who is facing or in a forced marriage.
Here is a quick guide on forced marriage:
According to the Forced Marriage Unit (FMU) there were over 1200 cases of forced marriage reported to them in 2015. The FMU is a Government led department which was set up in 2005 supporting victims and survivors of forced marriage. The FMU also receives calls from professionals who support victims and survivors of forced marriage including health care workers.
“A forced marriage is where one or both people do not (or in cases of people with learning disabilities, cannot) consent to the marriage and pressure or abuse is used. It is an appalling and indefensible practice and is recognised in the UK as a form of violence against women and men, domestic/child abuse and a serious abuse of human rights.” (Home Office, 2013)
It is very different to an arranged marriage where family or community members may take the lead in introducing two people however the final decision rests with the individuals who are to get married and requires their consent.
The majority of cases that the FMU deal with are female (80%) and there is a gender disparity however forced marriage does affect males too and is also linked to what is termed ‘honour’ abuse.
Honour abuse is about controlling behaviour of individuals who are deemed by perpetrators to have shamed families/communities because there is an honour system which has been broken. The honour system is about protecting cultural and perceived religious practices; however it is ultimately about asserting power and controlling behaviour. An example where this misguided notion of honour is broken is if a young woman is seen talking to males or for refusing a marriage or simply wearing makeup. Remember Shafilea Ahmed and Banaz Mahmod who were murdered because their families believed they dishonoured them? All these young women wanted was to be able to have the right to choose how to live which every person in the UK should have.
Doctors are in a position of trust and those who are experiencing abuse are more likely to be in contact with health services than any other professional agency (Boyle et al, 2005). UCLMS feels that it is important for trainee doctors to learn to identify the indicators to forced marriage and other types of abuse.
The NICE (2014) guidelines for domestic violence also recommend this and advise that it should be included in the curriculum.
Patients who are seen in health care settings may only get one chance and we cannot waste that opportunity because the person facing a forced marriage is at risk of kidnap, rape, torture and murder.
We as health workers have a duty of care and we should have a low threshold for asking about any type of abuse that a patient may be experiencing. Every person in the UK has the right to be safe and protected.
The signs are not always obvious because patients may present with something completely unrelated however we should ask patients about how they are and are they frightened of anything, anyone? We need to ask probing questions. We do not need to be experts however we do need to be aware that people from different backgrounds are at risk and that we should reassure individuals who disclose that it was the right thing to do and we should also seek advice from safeguarding teams where we work who may be better able to deal with this. As health workers we should not try and mediate with the family, this could in fact danger the life of the victim even further.
(Forced Marriage Unit Statistics 2015 and Multi-Agency Practice Guidelines 2014)
This is innovative and valuable because forced marriage UCLMS teaching started seven months ago. And will continue to be included in the core curriculum because it is important for our future doctors to have the confidence and knowledge to address forced marriage, a hidden issue with dire consequences.
The BBC news report talks to a victim of forced marriage and then highlights what is being done at UCLMS and features Year 5 medical students talking about why it is important they learn about it. Watch this link:
Let’s be leaders in this, we certainly are in a good position to do that!
Asma Ashraf, Research Nurse