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1.4.13 Female Genital Mutilation

NOTE

This chapter was added to the procedures manual in June 2014. It contains information on indicators that girls may be at risk of Female Genital Mutilation, explains protective steps which can be taken in such cases and outlines the law in relation to FGM.

FURTHER INFORMATION

Female Genital Mutilation Resource Pack (Home Office)

Leeds FGM Workflow

AMENDMENT

This chapter was updated in December 2015 to include information on the new mandatory reporting requirements for FGM (see Section 4, Mandatory Reporting of FGM).


Contents

  1. Definition
  2. Indicators
  3. NHS Actions
  4. Mandatory Reporting of FGM
  5. Protection and Action to be Taken
  6. Issues
  7. Further Information
  8. Law


1. Definition

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 makes it an offence for the first time for UK nationals or permanent 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. 

For more detail, please refer to the non-statutory government Multi-Agency Guidelines on Female Genital Mutilation (issued in February 2011).

Click here to access the Gov.uk website for Female Genital Mutilation.


2. Indicators

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.

The following are some signs that the child may be at risk of FGM:

  • The family belongs to a community in which FGM is practised;
  • The family makes preparations for the child to take a holiday, e.g. arranging vaccinations, planning an absence from school;
  • The child talks about a 'special procedure/ceremony' that is going to take place;
  • An awareness by a midwife or obstetrician that the procedure has already been carried out on a mother, prompting concern for any daughters, girls or young women in the family.

Consider whether any other indicators exist that FGM may have or has already taken place, for example:

  1. The child has changed in behaviour after a prolonged absence from school; or
  2. The child has health problems, particularly bladder or menstrual problems.

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.


3. NHS Actions

Since April 2014 NHS hospitals have been required to record:

  • If a patient has had Female Genital Mutilation;
  • If there is a family history of Female Genital Mutilation;
  • If a Female Genital Mutilation-related procedure has been carried out on a patient.

In addition, all acute hospitals must report this data centrally to the Department of Health on a monthly basis. This is 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.

For further information, see Information Standards Board for Health and Social Care, Female Genital Mutilation Prevalence Dataset Standard Specification.


4. Mandatory Reporting of FGM

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.

Procedure for Notifying West Yorkshire Police

Professionals should complete the West Yorkshire Police FGM Reporting Form and email to cib@westyorkshire.pnn.police.uk. The mail box is monitored 24 hours a day, seven days a week and upon receipt our operator will create an incident log and also a child protection report. The child protection report will be forwarded to the appropriate Safeguarding Unit child protection team to initiate police and partner investigation.


5. Protection and Action to be Taken

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 Contacts and 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 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.


6. Issues

Where is FGM Practised?

As a result of immigration and refugee movements, FGM is now being practiced 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:

  1. Severe pain and shock;
  2. Infection;
  3. Urine retention;
  4. Injury to adjacent tissues;
  5. Immediate fatal haemorrhaging.

Long-term implications can entail:

  1. Extensive damage of the external reproductive system;
  2. Uterus, vaginal and pelvic infections;
  3. Cysts and neuromas;
  4. Increased risk of Vesico Vaginal Fistula;
  5. Complications in pregnancy and child birth;
  6. Psychological damage;
  7. Sexual dysfunction;
  8. Difficulties in menstruation.

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 practise are multiple and reflect the ideological and historical situation of the societies in which it has developed. Reasons include:

  1. Custom and tradition;
  2. Religion, in the mistaken belief that it is a religious requirement;
  3. Preservation of virginity/chastity;
  4. Social acceptance, especially for marriage;
  5. Hygiene and cleanliness;
  6. Increasing sexual pleasure for the male;
  7. Family honour;
  8. A sense of belonging to the group and conversely the fear of social exclusion;
  9. Enhancing fertility.


7. Further Information

AFRUCA (Child Protection of African Children) 

Forward (Foundation for Women's Health Research and Development)

Multi Agency Practice Guidelines - Female Genital Mutilation

NSPCC - Fact sheet Female Genital Mutilation (FGM)

Female Genital Mutilation and its Management: Royal College of Obstetricians and Gynaecologists 2015


8. Law

The Female Genital Mutilation (FGM) Act was introduced in 2003 and came into effect in March 2004. The act:

  1. Makes it illegal to practice FGM in the UK;
  2. Makes it illegal to take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in that country;
  3. Makes it illegal to aid, abet, counsel or procure the carrying out of FGM abroad;
  4. Has a penalty of up to 14 years in prison and, or, a fine.

End