Female genital mutilation (FGM) is a collective term for procedures, which include the removal of part or all of the external female genitalia for cultural or other non-therapeutic reasons. The practice is medically unnecessary, extremely painful and has serious health consequences, both at the time when the mutilation is carried out and in later life. The procedure is typically performed on girls aged between 4 and 13, but in some cases it is performed on new-born infants or on young women before marriage or pregnancy.
FGM has been a criminal offence in the U.K. since the Prohibition of Female Circumcision Act 1985 was passed. The Female Genital Mutilation Act 2003 replaced the 1985 Act and made it an offence for the first time for UK nationals, permanent or habitual UK residents to carry out FGM abroad, or to aid, abet, counsel or procure the carrying out of FGM abroad, even in countries where the practice is legal.
The rights of women and girls are enshrined by various universal and regional instruments including the Universal Declaration of Human Rights, the United Nations Convention on the Elimination of all Forms of Discrimination Against women, the Convention on the Rights of the Child, the African Charter on Human and Peoples' Rights and Protocol to the African Charter on Human and Peoples' Rights on the rights of women in Africa. All these documents highlight the right for girls and women to live free from gender discrimination, free from torture, to live in dignity and with bodily integrity.
FGM has been classified by the World Health Organisation (WHO) into four types:
For more detail, please refer to the Multi-agency statutory guidance on female genital mutilation (April 2016).
These indicators are not exhaustive and whilst the factors detailed below may be an indication that a child is facing FGM, it should not be assumed that is the case simply on the basis of someone presenting with one or more of these warning signs. These warning signs may indicate other types of abuse such as forced marriage or sexual abuse that will also require a multi-agency response. See also Multi-agency statutory guidance on female genital mutilation, Annex B: Risk, for details.
The following are some signs that the child may be at risk of FGM:
Consider whether any other indicators exist that FGM may have or has already taken place, for example:
The Children's social care team will liaise with the Paediatric services where it is believed that FGM has already taken place to ensure that a Medical Assessment takes place.
It should be remembered that this will have lifelong consequences, and can be highly dangerous at the time of the procedure and directly afterwards.
If you are worried about a girl under 18 who is either at risk of FGM or who you suspect may have had FGM, you should share this information with Children's social care or the police, whichever is most appropriate see Protection and Action to be Taken.
From the 31st October 2015, regulated professionals in health and social care professionals and teachers in England and Wales have a duty to report 'known' cases of FGM in under 18s to the police see Mandatory Reporting of FGM.
Alerting the girl's or woman's family to the fact that she is disclosing information about FGM may place her at increased risk of harm.
It should not be assumed that families from practising communities will want their girls and women to undergo FGM.
Since April 2014 NHS hospitals have been required to record:
Since September 2014 all acute hospitals have been required to report this data centrally to the Department of Health on a monthly basis. This was the first stage of a wider ranging programme of work in development to improve the way in which the NHS will respond to the health needs of girls and women who have suffered Female Genital Mutilation and actively support prevention.A midwife/obstetrician/gynaecologist/General Practitioner may become aware that Female Genital Mutilation has occurred when treating a female patient. This should trigger concern for other females in the household.
From the 31st October 2015, regulated professionals in health and social care professionals and teachers in England and Wales have a duty to report 'known' cases of FGM in under 18s which they identify in the course of their professional work to the police.
'Known' cases are those where either a girl informs the person that an act of FGM - however described - has been carried out on her, or where the person observes physical signs on a girl appearing to show that an act of FGM has been carried out and the person has no reason to believe that the act was, or was part of, a surgical operation within section 1(2)(a) or (b) of the FGM Act 2003.
A failure to report the discovery in the course of their work could result in a referral to their professional body. The Home office has produced guidance Mandatory Reporting of Female Genital Mutilation - procedural information to support this duty.
Where concerns about the welfare and safety of a child or young person have come to light in relation to FGM a referral to Children's social care should be made in accordance with the Referrals Procedure.
Children's Social Care will undertake an assessment and, jointly with the Police, will undertake a Section 47 Enquiry if they have reason to believe that a child is likely to suffer or has suffered FGM. A strategy discussion/meeting should include the relevant Health professionals and, if the child is of school age, the relevant school representative.
Where a child has been identified as having suffered, or being likely to suffer, Significant Harm, it may not always be appropriate to remove the child from an otherwise loving family environment. Parents and carers may genuinely believe that it is in the girl's best interest to conform to their prevailing custom. Professionals should work in a sensitive manner with families to explain the legal position around FGM in the UK. The families will need to understand that FGM and re-infibulation (the process of resealing the vagina after childbirth) is illegal in the UK and that if they are insistent upon carrying out the practice, the health visitor and Children's social care must be informed that a female child may be at risk of significant harm. Interpretation services should be used if English is not spoken or well understood and the interpreter should not be an individual who is known to the family.
Where a child appears to be in immediate danger of mutilation, legal advice should be sought and consideration should be given, for example, to seeking a Female Genital Mutilation Protection Order, an Emergency Protection Order or a Prohibited Steps Order, making it clear to the family that they will be breaking the law if they arrange for the child to have the procedure.
The 2003 Female Genital Mutilation Act makes it illegal for any residents of the UK to perform FGM within or outside the UK. The punishment for violating the 2003 Act carries 14 years imprisonment, a fine or both.
Where is FGM Practised?
As a result of immigration and refugee movements, FGM is now being practised by ethnic minority populations in other parts of the world, such as USA, Canada, Europe, Australia and New Zealand. FORWARD estimates that as many as 6,500 girls are at risk of FGM within the UK every year.
There is no Biblical or Koranic justification for FGM and religious leaders from all faiths have spoken out against the practice.
Consequences of FGM
Depending on the degree of mutilation, FGM can have a number of short-term health implications:
Long-term implications can entail:
In addition to these health consequences there are considerable psycho-sexual, psychological and social consequences of FGM.
Justifications of FGM
The justifications given for the practice are multiple and reflect the ideological and historical situation of the societies in which it has developed. Reasons include:
FGM is a complex and sensitive issue that requires professionals to approach the subject carefully. An accredited female interpreter may be required. Any interpreter should ideally be appropriately trained in relation to FGM, and in all cases should not be a family member, not be known to the individual, and not be someone with influence in the individual's community.
Thought should be given to developing a safety and support plan in case the girl/woman is seen by someone 'hostile' at or near a meeting place, for example. agreeing in advance another reason why they are there.
In England and Wales, criminal and civil legislation on FGM is contained in the Female Genital Mutilation Act 2003 ('the 2003 Act'). The Act:
DHSC page on 'Safeguarding Women and Girls at Risk of FGM', which includes the guidance plus additional resources including a safeguarding pathway and risk assessment tools
Mandatory Reporting of Female Genital Mutilation - procedural information
Only valid for 48hrs