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Definition

Female Genital Mutilation (FGM) is Child Abuse

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 specific criminal offence in the UK since 1985 when the Prohibition of Female Circumcision Act 1985 Act was passed. In 2003 this was replaced by the Female Genital Mutilation Act 2003 in England, Wales and Northern Ireland. The 2003 Act modernised the offence of FGM and the offence of assisting a girl to carry out FGM on herself whilst also creating extra-territorial offences to deter people from taking girls abroad for mutilation. To reflect the serious harm caused, the 2003 Act increased the maximum penalty for any of the FGM offences from five to 14 years’ imprisonment. In 2015 the Serious Crime Act also created a new offence of failing to protect a girl from FGM. This means that if an offence of FGM is committed against a girl under the age of 16, each person who is responsible for the girl at the time of FGM occurred will be liable under this new offence. The maximum penalty for the new offence is seven years’ imprisonment or a fine or both.

The rights of women and girls are enshrined by various universal and regional instruments including the Universal Declaration of Human Rights, the United Nations Convention on the Elimination of all Forms of Discrimination Against Women, the Convention on the Rights of the Child, the African Charter on Human and Peoples’ Rights and Protocol to the African Charter on Human and Peoples’ Rights on the rights of Women in Africa. All these documents highlight the right for girls and women to live free from gender discrimination, free from torture, to live in dignity and with bodily integrity.

The Somali term for FGM is ‘Guddniin’ and the Sudanese word for FGM is ‘Tahur’.

Female genital mutilation has been classified by the World Health Organisation (WHO) into four types:

  • Type 1: Circumcision - Excision of the prepuce with or without excision of part or all of the clitoris;
  • Type 2: Excision (Clitoridectomy) - Excision of the clitoris with partial or total excision of the labia minora. After the healing process has taken place, scar tissue forms to cover the upper part of the vulva region;
  • Type 3: Infibulation (also called Pharaonic Circumcision) -This is the most severe form of female genital mutilation. Infibulation often (but not always) involves the complete removal of the clitoris, together with the labia minora and at least the anterior two-thirds and often the whole of the medial part of the labia majora;
  • Type 4: Unclassified - This includes all other procedures - harmful procedures on the female genitalia for non-medical purposes e.g. pricking, piercing, incising and cauterizing of the genital area, and any other procedure that falls under the definition of female genital mutilation given above.

For the purposes of family law all types of FGM (including type 4) constitute ‘significant harm.’ Professionals should have due regard to their wider safeguarding responsibilities as well as statutory reporting duties when consider type 4. In all cases an awareness of known risk factors and an individual risk assessment by a clinician will support decision to initiate safeguarding procedures as well as meet the reporting requirements.

It is noted that in the criminal courts decisions on whether type 4 constitutes an offence depends on the particular circumstances of each case.

For more detail, please refer to the Multi –agency statutory guidance on female genital mutilation April 2016.


Indicators

These indicators are not exhaustive and whilst the factors detailed below may be an indication that a child is facing/at risk 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. See also statutory guidance Annex B: Risk, for details.

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

  • A female child is born to a woman who has undergone FGM or whose older sibling or cousin has undergone FGM;
  • The family belongs to a community in which FGM is practised or have limited level of integration within UK community;
  • The family indicate that there are strong levels of influence held by elders and/or elders are involved in bringing up female children;
  •  If a female family elder is present, particularly when she is visiting from a country of origin, and is taking a more active/influential role in the family;
  • The family makes preparations for the child to take a prolonged holiday, e.g. arranging vaccinations, planning an absence from school;
  • The child may talk about a long holiday to country of origin or where FGM practice is prevalent;
  • The child talks about a ‘special procedure/ceremony’ that is going to take place;
  • 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;
  • 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.
  • Repeated failure to attend or engage with health and welfare services or the mother of a girl is very reluctant to undergo genital examination;
  • Where a girl from a practising community is withdrawn from Sex and Relationship Education they may be at risk from their parents wishing to keep them uninformed about their body and rights.

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;
  2. The child has health problems, particularly bladder or menstrual problems; and/or
  3. The child has difficulty walking, sitting or standing and may appear to be uncomfortable.

If you are worried about a girl under 18 who is either at risk of FGM or who you suspect she may have undergone FGM, you should share this information with Children’s social care or the police immediately, whichever is most appropriate see Protection and Action to be Taken.

Professionals must take into consideration that by alerting the girl’s or woman’s family to the fact that she is disclosing information about FGM may place her at increased risk of harm and professionals should therefore take sufficient steps to minimise this risk.

It should not be assumed that families from practising communities will want their girls and women to undergo 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 to the police see Mandatory Reporting of FGM.


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. Following consultation with social care professionals as well as other relevant professionals, only then will the police take action to ensure the girl/young woman is safe and her needs are prioritised.

‘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.

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 and a fact sheet on the New Duty for Health and Social Care Professionals and Teachers to Report Female Genital Mutilation (FGM).

If there are suspicions that a girl under the age of 18 years may have undergone FGM or is at risk of FGM professionals must still report the issue by following their internal safeguarding procedures. Professionals must share the information about their concerns, potential risk and/or the actions which are to be taken. Next steps should be discussed with the safeguarding lead and if necessary a social care referral made.


Protection and Action to be Taken

FGM is considered to be a form of child abuse (it is categorised under the headings of both physical abuse and emotional abuse) as it is illegal and is performed on a child who is unable to resist or give informed consent therefore it is essential that a referral into Cumbria Safeguarding Hub is made in accordance with the Multi-agency Thresholds Guidance (including Referrals) when a practitioner suspects FGM; where the situation is an emergency, the local police should be contacted immediately.

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:

  • The welfare of other children within the family, in particular female siblings, should be reviewed;
  • Immediate protection and support for the child/ren; and
  • That the practice is not perpetuated.

Liaison with FGM clinical leads in each NHS Trust or Forensic Medical Examiner at the Bridgeway Duty Paediatrician at the(Cumbria Sexual Assault Referral Centre) to discuss where it is believed that FGM has already taken place to ensure that a Medical examination takes place.

Where a child appears to be in immediate danger of mutilation, or there is a plan to take the child abroad to be subjected to FGM, legal advice should be sought and consideration should be given, for example, to seeking a Female Genital Mutilation Protection Order, a Police Protection Order, 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.

An appropriate response to a child or adult suspected of having undergone FGM, as well as a child at risk of undergoing FGM, could include:

  • Arranging for an interpreter if this is necessary and appropriate;
  • Creating an opportunity for the child to disclose, seeing the child on their own;
  • Using simple language and asking straight forward questions;
  • Using terminology that the child will understand (e.g. the child is unlikely to view the procedure as abusive);
  • Being sensitive to the fact that the child will be loyal to their parents;
  • Giving the child time to talk;
  • Getting accurate information about the urgency of the situation, if the child is at risk of being subjected to the procedure;
  • Giving the message that the child can come back to you again.

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.

FGM is a complex and sensitive issue that requires professionals to approach the subject carefully. An accredited female interpreter may be required. Any interpreter should ideally be appropriately trained in relation to FGM, and in all cases should not be a family member, not be known to the individual, and not be someone with influence in the individual’s community.

In light of this, professionals must give careful thought and consideration to developing a safety and support plan for the girl/woman prior to meeting with her. If a girl/woman is seen by someone within the community who she perceives as ‘hostile’ this may pose a risk to her safety. By mutually agreeing in advance another reason why they are there could potentially minimise this risk.


Multi-Agency Response

  • Each agency has specific guidance in relation to Female Genital Mutilation.

Regulated health and social care professionals and teachers in England and Wales have a mandatory reporting duty to report ‘known’ cases of FGM in under 18s which they identify in the course of their professional work to the police. This requirement is where the regulated professional observes physical signs on the girl which appear to show an FGM has been carried out, and the relevant professional has no reason to believe that the act was part of a permitted surgical procedure: or where the girl informs the relevant professional that an act of FGM has been carried out on her.

Health professionals in GP surgeries, sexual health clinics and maternity services are the most likely to encounter a girl or woman who has been subjected to FGM.

In health settings an individual risk assessment should be made by a clinician using an FGM risk assessment.

All professionals encountering a girl or woman who has undergone FGM should be alert to the risk of FGM in relation to her:

  • Younger siblings;
  • Daughters or daughters she may have in the future;
  • Extended family members;
  • All girls / women who have undergone FGM (and their boyfriends / partners or husbands) must be told that re-infibulation is against the law and will not be done under any circumstances. Each woman should be offered counselling to address how things will be different for her afterwards;
  • After childbirth, a girl / woman who has been de-infibulated may request and continue to request re-infibulation. This should be treated as a child protection concern, as the girl / woman's apparent reluctance to comply with UK law and / or consider that the process is harmful raises concerns in relation to girl child/ren she may already have or may have in the future. Professionals should consult with their agency's designated safeguarding children professional and with LA Children's Social Care about making a referral to them;
  • See also the BMA guidance: FGM: Caring for patients and child protection.




Law

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. 

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.

In England and Wales, criminal and civil legislation on FGM is contained in the Female Genital Mutilation Act 2003 (‘the 2003 Act’).

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.

As amended by the Serious Crime Act 2015, the Female Genital Mutilation Act 2003 now includes:

  1. Creating a new offence of failing to protect a girl from FGM with a penalty of up to 7 years in prison or a fine or both. - A person is liable if they are “responsible” for a girl at the time when an offence is committed. This will cover someone who has “parental responsibility” for the girl and has “frequent contact” with her and any adult who has assumed responsibility for caring for the girl in the manner of a parent. This could be for example family members, with whom she was staying during the school holidays;
  2. Introduced Female Genital Mutilation Protection Orders (“FGMPO”) - breaching an order carries a penalty of up to five years in prison. The terms of the order can be flexible and the court can include whatever terms it considers necessary and appropriate to protect the girl or woman;
  3. Allowing for the lifelong anonymity of victims of FGM – prohibiting the publication of any information that could lead to the identification of the victim. Publication covers all aspects of media including social media;
  4. Extended the extra-territorial reach of Female Genital Mutilation (FGM) offences to include “habitual residents” of the UK;
  5. Created a new duty of Mandatory Reporting of Female Genital Mutilation for regulated professionals in health and social care professionals and teachers in England and Wales which came into force on the 31st October 2015.

Amendments to this Chapter

In February 2017, this chapter was amended including the addition of a link to the DoH Female Genital Mutilation Risk and Safeguarding Guidance for Professionals was added.

End.