Female genital mutilation

Female Genital Mutilation (FGM) is a term used to refer to any practice which includes the removal or alteration of the female genitalia. FGM is illegal in the UK but is seen as an acceptable custom within certain cultures and communities.

  

Please note this procedure is being kept under review to reflect the work being carried out by the North East FGM Partnership Board, which LSCB's and their partners are represented on.

Definition and overview 

Even though FGM is a child protection issue which has a major impact on the health and wellbeing of the child – it can take place within otherwise loving and caring families, who genuinely believe there are acting in the best interest of the child. FGM must always be regarded as causing significant harm.

Consequently, local policy (especially in areas where there are communities within FGM which is prevalent) should contain a prevention strategy based on education and partnership. This section of the manual, however, concentrates on the impact of FGM on the child’s welfare and the professional response to instances of this. National multi agency practice guidance is available from this link: HM Government FGM Guidance  April 2016.

Legal position

FGM is a criminal offence under the Female Genital Mutilation Act 2003. The act also makes if offence for UK nationals or permanent residents to carry out, or aid, abet, counsel or procure the carrying out of FGM abroad – including for countries in which the practice is legal.

Mandatory reporting

Section 5B of the 2003 Act introduces a mandatory reporting duty which requires regulated health and social care professionals and teachers in England and Wales to report ‘known’ cases of FGM in under 18s which they identify in the course of their professional work to the police. The duty applies from 31 October 2015 onwards.

‘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

The duty is a personal duty which requires the individual professional who becomes aware of the case to make a report; the responsibility cannot be transferred. The only exception to this is if you know that another individual from your profession has already made a report; there is no requirement to make a second. Reports should be made by telephone or writing to the police.

Reports under the duty should be made as soon as possible after a case is discovered, and best practice is for reports to be made by the close of the next working day, unless any of the factors described below are present. You should act with at least the same urgency as is required by your local safeguarding processes. In order to allow for exceptional cases, a maximum timeframe of one month from when the discovery is made applies for making reports. However, the expectation is that reports will be made much sooner than this.

Further guidance is available from this link: Mandatory Reporting of Female Genital Mutilation – procedural information 

Prevalence

FGM is carried out in parts of Africa, and the Middle and Far East. It is also found in Western Europe – primarily amongst immigrant and refugee communities. It is estimated that 24,000 females under the age of 15 are at risk of FGM in England (see Dorkenoo et al 2007. Available from Forward UK). FGM is most commonly performed on females aged between 4 and 13 but can also be carried out on babies, younger children and older children.

Impact on children

FGM is carried out on children who cannot understand the full implications or exercise informed choice. The practice is painful and can have serious health implications (including death in some circumstances through blood loss or infection) both at the time of procedure and in later life. FGM can cause the following:

  • Shock Bleeding
  • Extreme pain 
  • Infection Spread of HIV and hepatitis (through the instruments used) 
  • Damage to the vaginal area 
  • Abscesses and tumors 
  • Infertility 
  • Scarring 
  • Bladder and kidney damage 
  • Pain during intercourse/increased risk of infection from intercourse 
  • Tearing/bleeding during childbirth (some women will need to be recut to allow birth to occur) 
  • Decreased sexual pleasure/fulfillment 
  • Feelings of humiliation and betrayal 

A child may be considered to be at risk if it is known that older girls in the family have been subject to the procedure. Pre-pubescent girls of 7 to 10 are the main subjects, though the practice has been reported amongst babies.

It should also be remembered that FGM can be the “norm” with specific communities and may play a part of acceptance and fulfilling the role of a female within the community expectations. Where that community is a minority within a wider society there may be immense psychological impact of a person who has been/will be subject to FGM, as they are caught between the specific expectations of their community and the wider cultural expectations of the wider society.

Parents and others who have subjected daughters or plan to subject daughters to FGM do not intend it as an act of abuse; they believe it is in the girl's best interest to conform to their prevailing custom. Agencies should work together to promote a better understanding of the damaging consequences to physical and psychological health of FGM. Wherever possible the aim must be to work in partnership with parents, families and communities to protect children through parents awareness of the harm caused to the child.

Potential indicators that FGM may have/could occur

  • Belonging to a community where FGM is practiced
  • Planned holidays/absence from school
  • Changes in behaviour or avoiding certain activities e.g. school PE following the procedure
  • Child referring to a “special procedure”
  • Health experts become aware that FGM has taken place on another family member e.g. from examination of a mother during pregnancy

Where a professional or agency believes a child is likely to suffer of has suffered FGM a child protection referral must be made.

In addition to normal attendance at the Strategy Meeting a professional with specific expertise must be invited and consideration should be given to inviting a legal adviser.

In planning any intervention it is important to consider the significance of cultural factors. Any intervention is more likely to be successful if it involves workers from, or with a detailed knowledges of the community concerned. FGM is a one-off event of physical abuse (albeit one that may have grave permanent sexual, physical and emotional consequences), not an act of repeated abuse and organisational responses need to recognise this.

If the child has already suffered FGM the meeting will need to consider carefully whether to continue enquiries or whether to assess the need for support services. The meeting should consider any other children in the family or household who may be at risk of FGM in the future.

A girl who has already been genitally mutilated should not normally be subject to a Child Protection Conference unless additional protection concerns exist. She should be offered counselling and medical help. Consideration must be given to any other female siblings at risk.

A girl believed to be in danger of genital mutilation may be made subject to a Child Protection Plan with the primary category of physical abuse. The Child Protection Plan should reflect an approach of awareness raising, education, support and persuasion.

 

Helpline

 

The Female Genital Mutilation Helpline is a UK-wide service.  It operates 24/7 and is staffed by specially trained child protection helpline counsellors who can offer advice, information, and assistance to members of the public and to professionals.  Counsellors are also to make referrals, as appropriate, to statutory agencies and other services.

The helpline can be contacted on:

0800 028 3550 and emails sent to fgmhelp@nspcc.org.uk

The aim of this specialist helpline is to improve the safeguarding of children in the UK by increasing the detection and protection of children at risk or who have become victims of female genital mutilation.  It will also facilitate, as necessary, the sharing of information with police and relevant agencies so that intelligence can be gathered and appropriate action taken against those who facilitate female genital mutilation against children.   It will work in the same way as the main NSPCC helpline.

Relevant links