Women are being let down by a lack of clarity over procedures for reporting incidents of female genital mutilation (FGM), the director of the Royal College of Midwives in Northern Ireland has said.
Seventeen cases of the illegal practice occurred in the Belfast Trust area in just over nine months (April 2017 to January 2018), and Breedagh Hughes said that as figures are not recorded here, it means in reality there are many more hidden victims.
"The fact that there have been no official, practical guidelines for nurses, midwives, social workers, anyone working at the coalface, means it's very difficult for anyone to know what to do when confronted with a case of FGM," she said.
"There are serious physical and psychological issues involved.
"We did receive great strategic guidelines from the Department of Health in 2014, but until we know exactly how many women are involved there's no way we can come up with a strategy on how to deal with it.
"New students are trained in the theory, but not in the practice. There's no system of keeping records, no guidelines in reporting incidents to police for over-18s. We need concrete guidelines across multiple disciplines on what to do. It's clear to me the numbers are greatly understated.
"There is also an issue of jurisdiction. If the offence was carried out on someone over-18 outside of Northern Ireland, what do they do?"
For a period between January 2016 and January 2018 it was found there were less than five cases in the Western and Northern Trusts, less than 10 recorded cases in the South Eastern Trust and no recorded cases in the Southern Trust.
FGM is defined by the NHS as "a procedure where the female genitals are deliberately cut, injured or changed, but where there's no medical reason for this to be done".
Natassa Latcham from the African and Caribbean Support Organisation NI said the communities affected were primarily Somalian and Sudanese.
She said: "Women are trying to show their own communities that this is a practice that needs to end.
"They want it known 'we're here and we have this major issue and we need more awareness created'."
The summer holidays are the most dangerous time for at-risk young girls as they return home. In England it's compulsory for doctors, hospitals and mental health trusts to report new cases.
In 2016-17 more than 5,000 cases were recorded there.