Female Genital Mutilation
Female Genital Mutilation (FGM) (previously known as female circumcision) has been illegal in the UK since 1985 and it is now illegal to arrange for a child to be taken out of the country for the purpose of FGM.
It is not an accepted ritual for any religion.
FGM is a collective term for all procedures which include the partial or total mutilation of the external female genital organs for cultural or other non-therapeutic reasons.
Legislation has been in place for many years. It is known that children are subject to this procedure both in the UK and overseas.
FGM is not an acceptable practice and is a form of child abuse under UK law.
Working Together to Safeguard Children (2006) recommends that the Local Safeguarding Children Board in areas where FGM is practiced should have detailed guidance for staff when they have concerns related to FGM. The guidance should also be combined with a preventative strategy involving community education. The purpose of these procedures is to fulfil our commitment under Working Together to Safeguard Children (2006) recommendations.
FGM has been illegal since the 1985 Female Circumcision Prohibition Act. The new FGM Act (2003) updates and extends the original Act.
It is now:
- An offence to take UK nationals and those with permanent UK residency overseas for the purpose of circumcision, to aid and abet, counsel or procure the carrying out of FGM. It is illegal for anyone to circumcise women or children for cultural or non-medical reasons.-
(Female Genital Mutilation Act 2003)
The FGM Act 2003 carries a maximum penalty of 14 years in prison for committing or aiding in this offence.
FGM covers a range of mutilation from the partial to total removal of the external female genital organs.
The World Health Organisation has classified FGM as four different procedures;
FGM Type 1 - Sunna - removal of the hood of the clitoris.
FGM Type 2 - Excision - removal of the clitoris with partial or total excision of the labia minora.
FGM Type 3 - Infibulation - removal of the clitoris, labia minora with narrowing by stitching of the vaginal opening.
FGM Type 4 - Gishiri cuts - all other types including pricking, cutting and piercing, inserting substances with any of the above.
FGM is a tradition practiced in parts of 28 African countries and parts of Asia and Latin American. The communities with the highest prevalence are generally from the Horn of Africa and include countries such as Somalia, Egypt, Mali, Guinea etc (C Momoh (2005) Female Genital Mutilation, Radcliffe, Oxford).
FGM is increasingly found in Western Europe and developed countries. In the UK there are populations of people from countries who practice FGM, some of these populations have settled in the South West. They maintain close cultural links to their country of origin. The women and girls in these families are at risk of FGM.
In the UK it has been estimated that up to 100,000 women and up to 10,000 children are at risk. Not all children from BME groups will be at risk of FGM, census information does not identify specific populations who practice FGM. This highlights the need for all staff to be aware of the signs that a child may be about to undergo FGM or has recently undergone this type of mutilation.
Many women, men and professionals appear to be unaware of the major health issues associated with FGM. The physical and mental trauma usually causes long term complications for these women. These include:
Chronic renal infection
Painful sexual intercourse
Difficulty with childbirth
Incontinence
Infertility is common
Emotional and behavioural problems
The procedure is associated with death from infection and haemorrhage
Reason given by communities for practicing FGM includes:
Custom and tradition;
Family honour;
Hygiene and cleanliness;
Preservation of virginity/chastity;
Social acceptance especially for marriage;
The mistaken belief that it is a religious requirement;
A sense of belonging to the group and conversely the fear of social exclusion
In the UK the complexities of the social interactions that surround this practice have led to collusion and secrecy within families when they are planning for FGM. This poses a huge challenge for staff who need to identify these risks and protect girls from FGM.
Some indicators that FGM may be about to or has already taken place.
If a family originates from a country that is known to practice FGM and:
A conversation with a child may refer to FGM i.e. she may express anxiety about a "special procedure", "pricking", "pinching my bottom" or an event that is to take place.
At school a prolonged absence and a noticeable change in the child's behaviour on their return, including a reluctance or inability to take part in physical activity.
Another girl or woman in the family has been mutilated.
A prolonged family trip to the country of origin or countries where FGM is practiced.
A child may spend long periods of time visiting the toilet during the day-perhaps indicating bladder or menstrual problems.
A midwife/obstetrician/gynaecologist/general practitioner/practice nurse may become aware that FGM has occurred when treating a female patient. This should trigger concern for other females in the household.
All agencies have a responsibility to recognise the signs and indicators and share and report appropriately, but Education and Health need to be especially vigilant
South West Local Children's Safeguarding Boards recognises that there may be no intent to harm a child through FGM. FGM does however cause serious physical and mental complications to the health of the girl and is regarded as a form of Physical Abuse.
South West Local Children's Safeguarding Boards aim to prevent the practice of FGM in a culturally sensitive manner with the greatest involvement of community representatives and professional groups as possible.
All agencies involved in the safeguarding and protection of children should be fully aware of FGM and have a policy within their own organisation. There should be a preventative strategy with a focus on education and training as well as protection of those at risk from harm.
Children identified to be at risk of FGM should be referred to Social Care or the Police. Social Care will consult the Community Paediatrician and the Police's Child Abuse Investigation Team following these initial concerns. This is called a strategy discussion.
FGM places a child at risk of significant harm and will therefore be investigated under section 47 of the Children Act 1989.
FGM should be discouraged through appropriate educational and preventative programmes aimed at all communities, but especially those who are known to practice FGM.
Professionals working in child protection should be aware of local preventative work relating to FGM in their locality.
New referrals should be managed according to the following guidelines:
An appropriately qualified female interpreter skilled in addressing issues of language, race and culture must be used. The Agency for Culture and Change Management (ACCM) will provide this training for interpreters.
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. Working sensitively within cultural and language parameters is also a priority
If no agreement is reached, the first priority is the protection of the child and the least intrusive legal action should be taken to ensure the child's safety.
A child thought to be in immediate danger of FGM where the parents are unable to ensure the safety of the child will need an Emergency Protection order.
A Prohibited Steps Order can be sought to stop parents who have decided to send the child overseas and mutilation is likely to take place.
Where there is no immediate danger to the children counselling and education clarifying the dangers and legal issue related to FGM for parents should be arranged.
Wherever possible the child would remain in the family and all the principles of good child protection work apply equally to this situation.
The primary focus is to prevent the child undergoing any form of FGM rather than removal from the family.
If a child has already undergone FGM and this comes to the attention of any professional, a referral should be made to Social Care or the Police Child Abuse Investigation Team. A strategy discussion will be convened to consider, how, where and when the procedure was performed and its implications for other female children in the family. If FGM has been undertaken in the UK the police will investigate and prosecution will be considered. All other female children within the family should also be considered to be at risk.
A child who has undergone FGM will be seen as a child in need and offered services as appropriate. Medical assessment and both short term and long term therapeutic services are to be considered at the strategy meeting.
The risk to other female children in the family must be considered at the strategy discussion.
If a woman has already undergone FGM and this comes to the attention of any professional e.g. midwife, GP or practice nurse, consideration needs to be given to any child protection implications e.g. for female siblings and extended family members. The professional must consider a referral to Social Care and share and document information appropriately.
If the woman is the mother of a female child or has the care of female children, professionals need to assess the potential risk to female children in the family and need to identify the most appropriate way of informing parents of the legal and health implications of FGM. This should be done in consultation with Social Care and an appropriately trained interpreter who has an understanding of FGM, the law and cultural sensitivity.
A child protection conference should be considered if there are unresolved child protection issues once the initial investigation and assessments have been completed
South West Local Children's Safeguarding Boards are committed to multi-agency training related to FGM and other cultural issues related to child protection. It is essential that each agency encourages appropriate staff to attend these training sessions.
All major single agencies (Police, Social Care, Health and Education) should undertake their own specific in house training related to FGM and this should be offered to all staff but targeted to staff working in areas of higher risk.
The training should include knowledge of the guidelines, recognising signs and symptoms of FGM being planned or having been performed, how to make a referral, and how to access support for victims of FGM.
For further reading and support see references, bibliography and local services.
HMSO (2003) The Female Genital Mutilation Act (2003)
www.opsi.gov.uk/ACTS/acts2003/20030031.htm
Royal College of Nursing (2006) ' Female Genital Mutilation Guidelines: An RCN educational resource for nursing and midwifery staff.
C Momoh (2005) Female Genital Mutilation, Radcliffe, Oxford
Adamson F (1992) Female genital mutilation: a counselling guide for professionals, London: FORWARD
Department for Education and Skills (2004) Female genital mutilation Act 2003: local authority social services letter (LASSL4), London: DfES. Available online at www.dfes.gov.uk
Royal College of Obstetricians and Gynaecologists (2003) Female genital mutilation (Statement no.3, May), London: RCOG. Available online at www.rcog.org.uk
World Health Organisation (2001) A systematic review of the health complications of female genital mutilation including sequelae in childbirth, Geneva: WHO. Available online at www.who.int
Africa Union (1986) African (Banjul) Charter on Human and People's Rights, AU: Addis Ababa, Ethiopia. Available online at www.africa-union.org
Office of the United Nations High Commissioner for Human rights (1987 & 2003) Convention against Torture and other Cruel, Inhuman or Degrading Treatment and Punishment, UNHCR: Geneva. Available online at www.ohchr.org
United Nations Population Fund (1994) International conference on population and development (ICPD), Cairo and ICPD+5 New York, and ICPD+10 Beijing, UNFPA: New York. Available online at www.unfpa.org
Global Consultant on Public Health
FGM & Surgical Reversal (GCPH)
10a Russell Gardens
London
N20 0TR
Tel: 0795 640 7063
www.fgmconsultancy.com
Black Women's Health and Family Support (BWHAFS)
82 Russia Lane
London
E2 9LU
Tel: 020 8980 3503
www.bwhafs.co.uk
WoMan being Concern International
K405 Tower Bridge Business Complex
100 Clements Road
London
SE16 4DG
Tel: 020 7740 1306
FORWARD (Foundation for Women's Health, Research and Development)
Unit 4
765 - 767 Harrow Road
London
NW10 5NY
Tel: 020 8960 4000
Short Term Health Implications
Severe pain and shock
Infections
Urine retention
Injury to adjacent tissues
Fracture or dislocation as a result of restraint
Damage to other organs
Behavioural changes and emotional upset
Death
Recurrent Urinary Tract Infections
Excessive damage to the reproductive system
Uterus, vaginal and pelvic infections
Difficulties in menstruation
Difficulties in passing urine
Increased risk of HIV transmission and Hepatitis B
Infertility
Cysts
Complications in pregnancy and childbirth
Psychological damage
Sexual dysfunction
This is difficult because:
It happens only once
Parents may believe FGM is a good thing to do for their daughters
The genitalia of girls are rarely examined
It is not culturally acceptable for girls to talk openly about FGM
There is a risk if:
The girl's mother or her older sisters have been cut
Mother has limited contact with people outside of her family
The female elders are very influential within the family
Mother has poor access to information about FGM
No one talks to the mother about FGM
Health, Social Service and Education staff fail to respond appropriately
Communities are given the impression that FGM is not taken seriously by the statutory sector
(Adapted from Foundation for Women's Health, Research and Development (FORWARD) cited RCN Guidelines for FGM)
Note: During any contact or assessment with the family a trained Female interpreter should always be used