Could FGM action push the practice back underground?
In the past few years, female genital mutilation has become a prominent issue in the UK, with a raft of measures brought in to fight it. But could one of those steps actually be pushing FGM back "underground"?
Alison Byrne has spent more than half of her 22-year career as a midwife helping pregnant women in the West Midlands who have previously undergone female genital mutilation.
And though she welcomes the work being done to tackle FGM, she fears some health bodies' decision to refer every woman with FGM who has a daughter to social services could be "quite dangerous".
Ms Byrne and a colleague set up a service at Birmingham's Heartlands Hospital in 2003 to help pregnant Somali women who had settled in inner-city Bordesley Green. Scar tissue and damage from FGM meant many babies could not be delivered vaginally. "Nobody knew what to do clinically," she said.
The service saw 109 women in its first year but by 2012, the number reached about 330. Ms Byrne said the number of pregnant women seen remained "steady", but now included women from "across the board" of 33 countries where FGM is practised.
It also gets about two referrals a week of women with FGM who are not pregnant, which she believes results from the "fabulous work" of community groups bringing a "very taboo topic" into the open.
"The difference in the last year has been that survivors are now coming forward and having the strength to stand up and talk about it. That has never happened in all the years I've been doing this," she said.
In recent years the government has begun collecting NHS data to bring a clearer picture of a "hidden" practice that has been illegal in the UK since 1985. Estimates by Equality Now and City University last year suggested 137,000 girls and women who have migrated to England and Wales have undergone FGM.
In the summer, new FGM Protection Orders, which enable officers to seize passports, were fast-tracked to protect girls who could be taken abroad for the procedure. And from next month, health and education professionals must report to police any cases in which a girl under 18 has had FGM.
Ms Byrne said none of the women she has seen had FGM performed in the UK but she does help women who fear their daughters could be cut if they visited their home countries.
"I tell them 'our law here protects your daughters'," she said.
While welcoming new laws, she was wary about some health bodies, including in parts of the Midlands and London, going further by referring every woman with FGM who has a daughter to social services "even before speaking to the women".
"You need to be careful not to victimise people," Ms Byrne said.
"If people are reporting every single lady that has had a daughter to social services then you have got a grave danger of the practice going well underground again. And all the good work I've been telling you about and how people are now coming forward, it will just go really quiet.
"And when we are, you ask that question 'have you had female circumcision' and women won't disclose it."
Coventry City Council's Health and Wellbeing Board refers women with FGM who give birth to a girl to children's social care, according to the West Midlands Police and Crime Panel report on FGM.
The referrals lead to a "joint visit" by care staff and West Midlands Police, who inform the woman FGM is illegal and find out if she is under pressure to "have FGM performed on her daughter", it said.
As a result, 57% of the force's FGM referrals are from Coventry, "demonstrating there is a very active referral policy", the report said. The force said its referrals were from medics and not crime figures, adding "subsequent investigations have shown that all of these took place overseas".
Ms Byrne said she tried to tackle the issue sensitively and advised women about help available, such as taking the government's FGM health passports, which state the practice is illegal in the UK, if they go overseas.
"What we are doing is working with the ladies and if there was ever a doubt in my mind where a child was at risk or an unborn was at risk I would be the first person making a safeguarding referral," she said.
"A big thing about the women I see is trust and word of mouth is very, very strong."
Sarata Jabbi, who is among FGM survivors speaking out about its devastating consequences, agreed such reporting to social services could be detrimental.
From a tribe called the Mandingo, for which the procedure is a "deeply-rooted" religious belief, she believes FGM must be tackled carefully. "Change can't take place by force," she said.
Ms Jabbi was seven when she was held down in a backyard in The Gambia and had her eyes and mouth covered before feeling "unbearable" pain.
She now lives in Birmingham and two years ago set up CAWAG (Care for Women and Girls) with friends. It now includes groups for girls, men and youths. Some members have trained as "community champions" to lead activities that raise awareness. It also reaches people through social media.
The mother-of-three said involving "grassroots groups" who help educate affected women and communities was the way forward.
"All the hospitals and all the FGM experts should work with the community groups, that is the only solution," she said.
Communities trusted such groups "because they speak the same language, they have the same kind of beliefs," she said.
"These people know their community better than the professionals."
Virginia Kamara, who runs partner community organisation Celestinecelest, said health services and other authorities in the UK were generally not led by people from FGM-practising communities, which she said was hampering progress in tackling this "very silent and secret" practice.
The nurse and health visitor from South Africa said there were concerns FGM victims were "getting younger" to bypass UK laws and FGM was being performed more on babies "as there is nothing in the system" if the children did not attend nursery.
The government's £3m FGM Prevention programme has included work to raise awareness and reach communities, such as through conferences and road shows.
Meanwhile, Coventry City Council said it was at the "forefront" of the fight to tackle FGM and was working with partners across the city.
"Key to the success is to be absolutely clear of the true extent of FGM, which can only be done through accurate reporting," a spokesperson said. "There is not an automatic referral to social care or the police, but there is a statutory duty for health services to record when they identify a woman with FGM.
"By doing this not only can partners build up the true picture of the extent of FGM in Coventry's communities but also continue the vital work to raise awareness of this illegal activity. We do not believe it has prevented anyone from using the city's health services."