FGM – resources for practitioners

The National FGM Centre is a partnership between Barnardo’s and the Local Government Association (LGA) to achieve a systems change in the provision of services for children and families affected by Female Genital Mutilation (FGM). Its remit includes Breast Ironing/Flattening and Child Abuse Linked to Faith or Belief.

The Centre’s website hosts an interactive knowledge hub which provides a ‘one-stop shop’ for quality assured national and international guidance, information and resources regarding FGM, Breast Flattening and Child Abuse Linked to Faith or Belief.

It helps to support the continued learning of professionals, the development of good practice, and the understanding of excellence in the delivery of services.

• Find out more on the National FGM Centre website at nationalfgmcentre.org.uk

The FGM Good Practice Guidance and Assessment Tool for Social Workers provides social workers with a range of questions to help them assess cases where FGM might be an issue.

• Find the tool on the National FGM Centre website at nationalfgmcentre.org.uk/fgm-assessment-tool (pdf)

Indications that FGM may be about to take place include:

• the family comes from a community that is known to practice FGM (in conjunction with any of the following)
• a child may talk about a long holiday to her country of origin or another country where the practice is prevalent, including African countries and the Middle East
• a child may confide to a professional that she is to have a ‘special procedure’ or to attend a special occasion;
• a child may request help from a teacher or another adult
• any female child 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
• a midwife / obstetrician may become aware that FGM has taken place when treating a pregnant woman. This should trigger concern for any female child of the family and result in educational/preventative input via health professionals in liaison with support groups
• any female child who has a sister who has already have undergone FGM must be considered to be at risk, as must other female children in the extended family.

Indications that FGM may have already taken place include:

• a child may spend long periods of time away from the classroom during the day with bladder or menstrual problems if she has undergone Type III FGM
• a prolonged absence from school with noticeable behaviour changes on the girl’s return could be an indication that a girl has recently undergone FGM
• professionals also need to be vigilant to the emotional and psychological needs of children who may/are suffering the adverse consequence of the practice (e.g. withdrawal, depression etc.)
• a child requiring to be excused from physical exercise lessons without the support of her GP
• a child may ask for help.

From 31 October 2015, healthcare professionals must report to the police any cases of female genital mutilation in girls under 18 that they come across in their work.  The support package includes documents that support the introduction of the duty and include:

• a poster explaining what the duty means for healthcare professionals
• guidance on what healthcare professionals should do if they think a child has had or is at risk of FGM
• a training package to introduce the duty to healthcare professionals
• a leaflet explaining the duty to patients.

Full information can be found on the gov.uk website at www.gov.uk/fgm-mandatory-reporting-in-healthcare

Health Education England (HEE) have launched an e-learning resource available from their website at www.e-lfh.org.uk/female-genital-mutilation/which is designed to raise greater awareness and help support healthcare professionals when working with women and girls who are victims of FGM.

Supported by the Department of Health’s FGM Prevention team, the e-learning resource focuses on issues related to health, legal status and referral pathways. The sessions are knowledge based and will provide practical support to healthcare professionals facing challenges such as how to approach a conversation about FGM with patients.

Any information or concern that a child is at immediate risk of, or has undergone, female genital mutilation should result in a child protection referral to children’s social care.

Where a child is thought to be at risk of FGM, practitioners should be alert to the need to act quickly – before the child is abused through the FGM procedure in the UK, or taken abroad to undergo the procedure.

On receipt of a referral, a strategy meeting / discussion must be convened within two working days, and should involve representatives from the police, children’s social care, education, health and voluntary services. Health providers or voluntary organisations with specific expertise (e.g. FGM, domestic violence and / or sexual abuse) must be invited, and consideration may also be given to inviting a legal advisor.

Every attempt should be made to work with parents on a voluntary basis to prevent the abuse. It is the duty of the investigating team to look at every possible way that parental co-operation can be achieved, including the use of community organisations and / or community leaders to facilitate the work with parents / family. However, the child’s interest is always paramount.

If no agreement is reached, the first priority is protection of the child and the least intrusive legal action should be taken to ensure the child’s safety.

If the strategy meeting / discussion decides that the child is in immediate danger of mutilation and parents cannot satisfactorily guarantee that they will not proceed with it, then an emergency protection order should be sought.

The FGM Good Practice Guidance and Assessment Tool for Social Workers provides social workers with a range of questions to help them assess cases where FGM might be an issue and can be found on the National FGM Centre’s website at nationalfgmcentre.org.uk/fgm-assessment-tool (pdf)

The helpline will give advice, information and support for anyone concerned that a child’s welfare is at risk because of female genital mutilation.

Though callers’ details can remain anonymous, any information that could protect a child from abuse will be passed to the police or social services.

If you are worried that a child may be at risk of FGM, you can contact:

• the 24 hour helpline anonymously on 0800 028 3550
• or email fgmhelp@nspcc.org.uk Female Genital Mutilation.

For more information visit their website at www.nspcc.org.uk/female-genital-mutilation-fgm/

FGM is prevalent in Africa, the Middle East and Asia.

In the UK, FGM tends to occur in areas with larger populations of communities who practice FGM, such as first-generation immigrants, refugees and asylum seekers. These areas include Manchester.

The World Health Organisation (WHO) defines female genital mutilation (FGM) as:

“All procedures which involve partial or total removal of the external female genitalia or injury to the female genital organs whether for cultural or other non-therapeutic reasons. (WHO, 1996).”

FGM is sometimes referred to as female circumcision, but FGM is the preferred term because mutilation is a more honest description of the physical and emotional dangers involved.

It is illegal in the UK to subject a child to female genital mutilation – or to take a child abroad to undergo FGM. All forms of FGM are illegal under the Female Genital Mutilation Act (2003)

FGM is more prevalent in the UK than we would expect, but due to its underground nature few direct allegations are  made.

A child for whom FGM is planned is at risk of significant harm through physical abuse and emotional abuse.

Significant harm is defined as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

The World Health Organisation (WHO) divides the FGM procedure into four major types. All types carry a high risk of infection, including HIV transmission, complications and fatality. The procedure is often not carried out in a sterile environment with clean instruments; it is usually perpetrated by the female elders.

• For more information visit the WHO website at  www.who.int/

Type I
The WHO defines Type I FGM as the partial or total removal of the clitoris (clitoridectomy) and/or the prepuce (clitoral hood) and is regarded as the mildest form of FGM, but seems to only be undertaken on a small number of girls and women.

Type II
The WHO’s definition of Type II FGM is “partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora”.

Type III
The WHO defines Type III FGM as narrowing of the vaginal orifice with creation of a covering seal by cutting and repositioning the labia minora and/or the labia majora, with or without excision of the clitoris leaving an artificial hole the size of a matchstick to allow the flow of urine and menstrual blood (infibulation). It is the most extensive form of FGM.

A reverse infibulation is often performed to allow for sexual intercourse or when undergoing labour. In some communities, the man forces reverse infibulation during the first sexual act to demonstrate his virility.

Women who have been infibulated face a lot of difficulty in delivering children, especially if the infibulation is not undone beforehand, which often results in severe tearing of the infibulated area, or foetal death if the birth canal is not cleared.

The risk of severe physical and psychological complications is more highly associated with women who have undergone infibulations as opposed to one of the lesser forms of FGM. Although there is little research on the psychological side effects of FGM, many women feel great pressure to conform to the norms set out by their community, and suffer from anxiety and depression as a result.

Type IV
There are other forms of FGM, collectively referred to as Type IV. The WHO defines Type IV FGM as “all other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterization.”

This includes a diverse range of practices, such as pricking the clitoris with needles, burning or scarring the genitals as well as ripping or tearing of the vagina.

Female genital mutilation is a complex issue. Despite the harm it causes, many women from FGM practising communities consider FGM normal to protect their cultural identity.

Although FGM is practiced by secular communities, it is most often claimed to be carried out in accordance with religious beliefs.

However, neither the Bible nor the Koran supports the practice of FGM.

It is reported to be practiced in 28 African countries from the Gambia to Somalia and parts of the Middle and Far East. It has been reported in immigrant African populations in the UK.

In addition to giving religious reasons for subjecting their daughters to FGM, parents say they are acting in a child’s best interests because it:

• brings status and respect to the girl
• preserves a girl’s virginity / chastity
• is a rite of passage
• gives a girl social acceptance, especially for marriage
• upholds the family honour
• helps girls and women to be clean and hygienic.

The age at which girls are subjected to female genital mutilation varies greatly, from shortly after birth to any time up to adulthood. The average age is 10 to 12 years.

Short-term health implications can range from severe pain and emotional / psychological trauma to, in some cases, death.

The health problems caused by FGM Type III are severe – urinary problems, difficulty with menstruation, pain during sex, lack of pleasurable sensation, psychological problems, infertility, vaginal infections, specific problems during pregnancy and childbirth, including flashbacks.

Women with FGM Type III require special care during pregnancy and childbirth.

This statement opposing female genital mutilation (FGM) can be taken abroad to explain the criminal status of FGM in the UK. It outlines what FGM is, the legislation and penalties involved and the help and support available. The statement is available in a number of languages.

Also called the statement opposing female genital mutilation, the FGM health passport is small enough to fit in a purse or wallet, and holds lots of help and information about FGM.

• Download the passport from the gov.uk website at www.gov.uk/statement-opposing-female-genital-mutilation and carry it with you.

Home Office FGM fact sheet (with translations)- available on their website at www.gov.uk/fact-sheet-on-mandatory-reporting-of-female-genital-mutilation

National Multi-Agency guidelines – available on their website at  www.gov.uk/multi-agency-statutory-guidance-on-female-genital-mutilation

FGM Resource Pack – available on their website at www.gov.uk/female-genital-mutilation-resource-pack

Home Office free e-learning course – useful for anyone who is interested in gaining an overview of FGM, particularly front-line staff in healthcare, police, border force and children’s social care available on the website www.virtual-college.co.uk/recognising-and-preventing-fgm

FORWARD (Foundation for Women’s Health Research and Development) is committed to gender equality and safeguarding the rights of African girls and women.  FORWARD provides support and advice for girls and women at risk of FGM; visit their website at forwarduk.org.uk for more information.

Greater Manchester’s former Police and Crime Commissioner ran a campaign to teach children in schools about the risks of female genital mutilation. The resources can be fond on the website www.gmpcc.org.uk/tools-and-resources/female-genital-mutilation/

NHS advice can be found on their website at www.nhs.uk/Conditions/female-genital-mutilation/

Daughters of Eve is a non profit organisation that works to protect girls and young women who are at risk from female genital mutilation (FGM). By raising awareness about FGM and sign-posting support services they aim to help people who are affected by FGM and ultimately help bring an end to this practice – find out more on their website at www.dofeve.org/

NSPCC information about Female Genital Mutilation (FGM) can be found on their website at  https://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/female-genital-mutilation-fgm/

Web app for young people, both girls and boys, living in the UK who want to find out more about Female Genital Mutilation (FGM) can be downloaded from the website petals.coventry.ac.uk/

LGA Resource
Information for Councillors and those working to tackle female genital mutilation (FGM) is available from the LGA website at www.local.gov.uk/female-genital-mutilation