Contents

Procedure Flowcharts

  1. Referral to Children's Social Care
  2. Action following assessment
  3. Urgent action to safeguard children
  4. What happens after the strategy discussion?
  5. What happens after the child protection conference, including the review process?

Female Genital Mutilation

What is Female Genital Mutilation?

FGM is a fundamental violation of the rights of girls.  It is discriminatory and violates the rights to equal opportunities, health, freedom from violence, injury, abuse, torture and cruel or inhuman and degrading treatment, protection from harmful traditional practices, and to make decisions concerning reproduction.  These rights are protected in international law.

Female genital mutilation (FGM), which is often also referred to as 'female circumcision' or ‘female cutting’, comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons.

FGM is a long established and open social custom in parts of Northern and Central Africa but is also practiced in secrecy in the Middle East with evidence found in Jordan, Saudi Arabia, Syria, Iraq, Oman, United Arab Emirates and Iraqi Kurdistan.

The World Health Organisation has identified the following countries as having FGM prevalence rates of between 50 – 98%: Burkina Faso, Djibouti, Egypt, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Sierra Leone, Somalia, and Sudan.  Chad and Cote d’Ivoire have prevalence rates of 45%.

FGM is considered child abuse in the UK and is illegal.  It is a grave violation
of the human rights of women and girls.  In all circumstances where FGM
is practised on a child it is a violation of the child’s right to life,
their right to their bodily integrity, as well as their right to health.

The extent of the problem in the UK

FGM is occasionally performed in the UK on girls from families who have emigrated from countries where FGM is practiced.  However, there is limited evidence of the exact extent of the problem in the UK, but The Foundation for Women's Health, Research and Development (FORWARD) estimates that there are presently 86,000 first generation immigrant and refugee women and girls in the UK who have undergone FGM in their countries of origin, with more than 7,000 girls at risk[1].

As with forced marriage, there is to date no official collection of statistics of the extent of the problem in the UK.  However, FGM is likely to occur with immigrant communities in Newcastle who have come from countries where the practice is common place. 

Why is FGM carried out?

Parents who force their daughters to undergo FGM often justify their behaviour as protecting their children, or preserving cultural or religious traditions.  They typically do not see anything wrong with their actions.  Many girls will have the expectation that they will experience FGM and may not be aware that they have a fundamental human right not to have this take place.

FGM is used as a means of controlling and de-sexualising women, repressing their sexual desire and to reduce the chance of their being sexual promiscuous.  FGM is also carried out for reasons of aesthetics and hygiene and as a means of purification and ensuring that a woman is clean.

These motivations help us to understand why parents might force their daughters to undergo FMG, but they cannot be used as a justification for subjecting women and girls to such harmful practices.   

FGM is not a religious practice.  It has been condemned
by every major faith group, including Islam, Sikh, Hindu
and Christian and no religious text requires it of women

What are the signs that a girl may be at risk of, or have already undergone FGM?

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 girl 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

The following are some signs that FGM may already have taken place:

  • Prolonged absence from school and noticeable behaviour change on return to school
  • Avoidance of specific classes or activities such as PE or sports, giving reasons of bladder, menstrual or abdominal problems
  • Girls finding it difficult to sit still in class or looking uncomfortable when sitting
  • Girls complaining of pain between their legs, or talking about something someone did that they are not allowed to talk about.

Girls are at particular risk of FGM during school summer holidays.
This is the time when families may take their children abroad for the procedure.
Many girls may not be aware that they may be at risk of undergoing FGM.

If you suspect that someone you know is at risk of being subjected to
any form of FGM, you should take action to report it immediately.
Time counts so please act as soon as you suspect that a girl may be at risk of FGM.

If you are concerned that a British citizen may be taken overseas
for the purpose of FGM please call the Foreign and Commonwealth
Office on 0207 008 1500 or email fgm@fco.gov.uk

What are the consequences of FGM?

There is generally limited data available on the effects of FGM, but for example it is estimated that in the Sudan one-third of girls who undergo FGM will die as a result.  Where medical facilities are not easily accessible or are ill-equipped, emergencies arising from the practice cannot be treated. Thus, a girl who develops uncontrolled bleeding or infection after FGM may die within hours.  It is important, for this reason to remember that families in the UK will usually take their daughters abroad for the procedure. 

Despite FGM being illegal, there are doctors in the UK who have been willing to carry out the practice on young girls.  There is evidence of doctors being struck off the medical register by the General Medical Council for carrying out FGM, but to date there has been no prosecution in the UK.  Even when the procedure is carried out by medical professionals who use surgical instruments and anaesthetics, this does not decrease the likely negative health consequences.

FGM is known to have potentially serious health consequences for women and girls, both psychological and physical.  Although it has so far been difficult to document its psychological effects, a number of immediate and long-term physical consequences have been identified.

Immediate complications

  • Severe pain and haemorrhaging
  • Shock and fever
  • Tetanus or sepsis
  • Urine retention and urinary infection
  • Ulceration and infection of the genital region
  • Injury to the adjacent tissue

Long term consequences

  • Anaemia
  • Cysts and abscesses
  • Scarring and hypersensitivity of the genital area
  • Damage to the urethra and other organs resulting in incontinence, recurring bladder and urinary tract infections
  • Painful sexual intercourse and sexual dysfunction
  • Infibulation can cause scar formation, difficulty in urinating and menstrual disorders
  • Infertility as a result of earlier infections
  • Prolonged and obstructed labour which can lead to fistulas, uterine rupture, brain damage to the infant and maternal and infant death
  • Women who have undergone FGM are twice as likely to die in childbirth and are more likely to give birth to a still born child than any other woman.

What can professionals do?

Although in Newcastle the number of women and girls at risk of FMG is likely to be relatively small in number, there will still be some women and girls who have already undergone the procedure or could be under pressure to have it performed.  It is therefore important for all professionals including members of the police, teachers, health care staff and social care staff who work with girls and young women throughout Newcastle to be aware of FGM.

Labels of 'tradition' 'culture' 'religion' or a fear of being called
a 'racist' should not stop action being taken to protect girls at risk
of FGM.  It is a form of child abuse and a violation of human rights.

In dealing with cases of FGM, it is important to take a victim centred approach.  The role of professionals in providing care and support for women/girls who have experienced or are at risk of FGM include:

  1. Be aware, be informed.  Take steps to become aware of local minority ethnic communities which support FGM, and of the special needs of the women and girls in those communities. 
  2. Be sensitive.  Do not make assumptions about the woman’s own views.  Many women from communities which practise FGM oppose to it, but there are others who do not.  It is important to be aware of the possible adverse psychosocial consequences for women and girls who have moved from a country where FGM is the norm, to one where it is illegal and generally abhorred.
  3. Assess individual needs.  Do not expect women to volunteer information about FGM, or about any problems it has caused.  Asking about circumcision when providing antenatal care to women from the communities concerned will help identify the additional needs that women who have undergone FGM will have during their pregnancy, labour and delivery and for postnatal care.  It is important that language used to describe FGM should be respectful and is not insulting to individuals, their culture or tradition. 
  4. Inform and explain.  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 any female child may be at risk.  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.  Again it is important to be mindful of language used to describe and discuss FGM.
  5. Involve and inform other care professionals.   If a professional is concerned that FGM is going to be or has been performed on a child or young woman, they should follow the processes in their agency Child Protection Procedures to make a child protection referral, as well as alerting the health visitor and any social workers involved with the family.  In such a situation, professionals should be mindful of other females in the family, including babies.  UK Legal framework and prohibitions on FGM

In England, Wales and Northern Ireland, all forms of FGM are illegal under the Female Genital Mutilation Act 2003.

FGM is an offence which extends to acts performed outside of the UK and to any person who advises, helps or forces a girl to inflict FGM on herself.  Any person found guilty of an offence under the Female Genital Mutilation Act 2003 will be liable to a fine or imprisonment of up to 14 years, or both.

FGM is considered to be a form of child abuse.  Under the Children Act 1989 Local Authorities can exercise their powers under Section 47 and can apply to the Courts for various Orders to prevent a child being taken abroad for mutilation.

FGM and Asylum

The Home Office has publicly condemned FGM, stating that any woman or child fearing this violence should have grounds for asylum.  However, only a very small number of women have been granted asylum in the UK and worldwide on the grounds of FGM.  Many obstacles hinder the asylum process protecting of women fleeing FGM including concerns about cultural imperialism, credibility and a lack of firm evidence, together with a lack of knowledge and awareness of the complexity of the issues surrounding the practice

For further information or guidance on dealing with FGM
and related issues:

FORWARD - Foundation for Women’s Health, Research and Development

Unit 4, 165-767 Harrow Road, London, NW10 5NY

0208 9604000  or  0208 9604014

forward@forwarduk.org.uk

www.forwarduk.org.uk

Hospitals and Clinics in the UK offering Specialist FGM Services

For a list and contact details of Hospitals and Clinics in the UK
offering specialist Female Genital Mutilation (FGM) health services
go to the  following link  
http://www.forwarduk.org.uk/resources/support/well-woman-clinics

National FGM resources

Please follow the links below to download a new poster and information leaflet to raise awareness of FGM:

  FGM poster
  FGM information leaflet

The government FGM webpages have now gone live at www.fco.gov.uk/fgm, and an email address has been set up at fgm@fco.gov.uk for anyone with concerns or questions about FGM.