5.14 Female Genital Mutilation
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 age at which girls undergo FGM varies enormously according to the community however it is typically performed on girls aged between 5 and 8, but in some cases it is performed on new-born infants or on young women before marriage or pregnancy.
FGM is much more common than is generally realised both worldwide and in the UK. It is deeply embedded into the culture of communities and intervention by statutory agencies may be resented.
FGM cannot be left to personal preference or cultural custom as it is an extremely harmful practice which violates basic human rights.
FGM is illegal in the UK The Female Genital Mutilation Act 2003 makes it an offence 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.
It is reportedly practiced in 28 African countries and in parts of the Middle East and Asia, but it is increasingly found in Western Europe and other developed countries. Victims of FGM are likely to come from a community that is known to practice FGM. UK Communities that are most at risk of FGM include Kenyan, Somali, Sudanese, Serra Leonean, Egyptian, Nigerian and Eritrean. Non African communities include Yemeni, Afghani, Kurdish, Indonesia and Pakistani.
For more detail, please refer to the Non-Statutory Government Multi-Agency Guidelines: Female Genital Mutilation.
2. Referral and Assessment
Specific factors that may heighten a girl’s or woman’s risk of being affected by FGM
There are a number of factors in addition to a girl’s or woman’s community that could increase the risk that she will be subjected to FGM:
- The position of the family and the level of integration within UK society – it is believed that communities less integrated into British society are more likely to carry out FGM;
- Any girl born to a woman who has been subjected to FGM must be considered to be at risk, as must other female children in the extended family;
- Any girl who has a sister who has already undergone FGM must be considered to be at risk, as must other female children in the extended family;
- Any girl withdrawn from Personal, Social and Health Education or Personal and Social Education may be at risk as a result of her parents wishing to keep her uninformed about her body and rights.
If any agency becomes aware of a child who may have been subjected to or is at risk of FGM they must make a referral to Children’s Social Care Services as Child In Need.
All professionals need to consider whether any other indicators exist that FGM may have or has already taken place, for example:
- A girl or woman may have difficulty walking, sitting or standing;
- A girl or woman may spend longer than normal in the bathroom or toilet due to difficulties urinating;
- A girl may spend long periods of time away from a classroom during the day with bladder or menstrual problems;
- A girl or woman may have frequent urinary or menstrual problems;
- There may be prolonged or repeated absences from school or college;
- A prolonged absence from school or college with noticeable behaviour changes (e.g. withdrawal or depression) on the girl’s return could be an indication that a girl has recently undergone FGM;
- A girl or woman may be particularly reluctant to undergo normal medical examinations;
- A girl or woman may confide in a professional;
- A girl or woman may ask for help, but may not be explicit about the problem due to embarrassment or fear.
There may be older women in the family who have already had the procedure and this may prompt concern as to the potential risk of harm to other female children in the same family.
What to do if you are concerned about someone who is at risk of FGM
Talk to them about your concerns, but use simple language and straightforward questions. Be sensitive and let them know that they can talk to you again.
FGM is known by a variety of names, including ‘female genital cutting’, ‘circumcision’ or ‘initiation’. The term ‘female circumcision’ is anatomically incorrect and misleading in terms of the harm FGM can cause. The terms ‘FGM’ or ‘cut’ are increasingly used at a community level, although they are not always understood by individuals in practising communities, largely because they are English terms.
A child at risk of forced marriage or FGM may also be at risk of honour based abuse. Extreme caution should be taken in sharing information with any family members or those with influence within the community as this may alert them to your concerns and may place the child in danger.
If you have concerns that a child is at risk you should contact Children’s Services and/or Norfolk Constabulary without delay:
Children’s Services: 0344 800 8020
Norfolk Constabulary: 101 or in urgent cases dial 999
The Children’s Social Care Services team in partnership with the Police Child Abuse Investigation Unit 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 is a one-off act of abuse to a child, although it will have lifelong consequences, and can be highly dangerous at the time of the procedure and afterwards.
Children Services should with the Police exercise its powers to make enquiries to safeguard a girl’s welfare under section 47 of the Children Act 1989 if it has reason to believe that a girl is likely to be subjected to or has been subjected to FGM.
However, despite the very significant severe physical and mental health consequences, parents and others who have FGM performed on their daughters do not intend it as an act of abuse – they believe that it is in the girl’s best interests to conform to their prevailing custom but it must not be excused, accepted or condoned.
Therefore, where a girl has been identified as suffering or likely to suffer Significant Harm, it may not always be appropriate to remove the child from an otherwise loving family environment. Where a girl appears to be in immediate danger of FGM, consideration should be given to legal Interventions such as, Police protection, Emergency Protection Orders under section 44 of the Children Act 1989, Care Orders and Supervision Orders, Inherent jurisdiction, Applications for wardship, or Repatriation back to the UK.
Professionals have a responsibility to ensure that families know that FGM is illegal, and the family will be breaking the law if they arrange for the child to have FGM. This knowledge alone, that the authorities are actively tackling the issue, may deter families from having FGM performed on their children, and save girls and women from harm.
4. NHS Actions
From April 2014 NHS hospitals will be 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.
From September 2014 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.