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6.14 Female Genital Mutilation

RELEVANT DOCUMENTS

Since February 24th 2011 practice guidance has been available called Female Genital Mutilation – New Multi-Agency Guidelines (these are expected to be updated later during 2016). These non-statutory Guidelines do not represent a change in the law, but largely consolidate what is regarded as existing good practice. They stress the need for all agencies to be conscious of issues surrounding Female Genital Mutilation (FGM), and include specific guidance for front-line professionals such as teachers, health professionals, social workers and police officers, together with a list of useful organisations.

Further guidance was issued in July 2015 in relation to Female Genital Mutilation Protection Orders. See "Get a female genital mutilation protection order" (GOV.UK) and Female genital mutilation documents (Home Office, March 2013).

A new mandatory reporting duty for FGM was introduced via the Serious Crime Act 2015, following a public consultation. The duty will require regulated health and social care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police. It came into force on 31 October 2015.

Further information can be accessed on the Home Office and Foreign Office websites.

Click here to view Female Genital Mutilation (FGM) Factsheet.

See also: GOV.UK Female genital mutilation: resource pack

Statement opposing female genital mutilation (Government Website) outlines what FGM is, the legislation and penalties involved and the help and support available. Often referred to as a health passport, that girls and young women are encouraged to put in their passports.

AMENDMENT

Significant changes have been made in this chapter throughout and can be seen in red text. March 2016.


Contents

  1. Legal Status
  2. Cultural Underpinnings
  3. Types of Female Genital Mutilation
  4. Implications of Female Genital Mutilation for a Child's Health and Welfare
  5. Identifying a Child who has been Subjected to Female Genital Mutilation or who may be at Risk of Being Abused through Female Genital Mutilation
  6. Responding to the Risk of Female Genital Mutilation - Referral to Children's Services
  7. FGM Protection Order Applications
  8. Responding to Female Genital Mutilation - the Role of Health
  9. Reducing the Prevalence of Female Genital Mutilation


1. Legal Status

The World Health Organisation (WHO) defines female genital mutilation (FGM) as: "all procedures (not operations) 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).

It is illegal in the UK to subject a child to female genital mutilation or to take a child abroad to undergo FGM. In England, Wales and Northern Ireland all forms of FGM are illegal under the Female Genital Mutilation Act 2003 and in Scotland it is illegal under the Prohibition of FGM (Scotland) Act 2005,the penalty may be up to 14 years in prison and, or, a fine.

A child for whom FGM is planned is suffering or likely to suffer significant harm through physical abuse and emotional abuse, which is categorised by some also as sexual abuse. See Definitions and Recognition of Abuse and Neglect Procedure.

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. Children Act 1989.


2. Cultural Underpinnings

Female genital mutilation (FGM) is a complex issue. Despite the harm it causes, many women from FGM practicing 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. 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


3. Types of Female Genital Mutilation

Female genital mutilation (FGM) has been classified by the 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 on the female genitalia, and any other procedure that falls under the definition of female genital mutilation given above.


4. Implications of Female Genital Mutilation for a Child's Health and Welfare

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 3 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 3 require special care during pregnancy and childbirth.


5. Identifying a Child who has been subjected to Female Genital Mutilation or who may be at Risk of Being Abused through Female Genital Mutilation

Indications that Female Genital Mutilation (FGM) may be about to take place include:

  • The family comes from a community that is known to practise FGM;
  • When a female family elder, visiting from another country is around (particularly where FGN is a cultural practice);
  • Where FGM is heard in conversation by a professional, i.e. where a girl tells other children about it, confides that she is to have a special procedure or attend a special occasion to become a woman;
  • A child may confide to a professional that she is to have a 'special procedure' or to attend a special occasion;
  • 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;
  • Where parents state that they or a relative will take the child out of the country for a prolonged period;
  • A child may request help from a teacher or another adult;
  • 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;
  • Where parents seek to prevent their children from learning about FGM.

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 3 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;
  • A girl may have difficulty walking, sitting or standing and may even look uncomfortable. She may specifically talk about pain or discomfort between her legs;
  • A girl may have frequent urinary, menstrual or stomach problems;
  • 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.


6. Responding to the Risk of Female Genital Mutilation - Referral to Children's Services

Any information or concern that a child is at immediate risk of, or has undergone, female genital mutilation (FGM) should result in a child protection referral to Children's Services in line with the Referrals Procedure.

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. When a referral is recieved local authorities should refer to the Multi-agency Practice Guidelines.

On receipt of a referral of a girl who is assessed to be at risk of FGM, a Strategy Discussion and Meeting must be convened within two working days, and should involve representatives from the police, Children's Services, 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 adviser. A Children's Services Manager should chair the Strategy Discussion Meeting.

If the Strategy Discussion/Meeting 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 or other means to secure the safety of the girl should be considered including consideration of an FGM Protection Order (Legal advice should be sought).

A Child Protection Conference should only be considered necessary if there are unresolved child protection issues once the initial investigation and assessment have been completed.

If the child has already undergone FGM, the Strategy Discussion/Meeting will need to consider carefully whether to continue enquiries or whether to assess the need for support services. If any legal action is being considered, legal advice must be sought.

Where FGM has been practised, the Joint Child Protection Investigation Team (JCPIT) will take a lead role in the investigation of this serious crime, working to common joint investigative practices and in line with strategy agreements.

Safeguarding girls at risk of FGM poses specific challenges as the families involved may give no other cause for concern. For example, they may in all other respects be loving and caring parents and have good relationships with their children. However, there remains a duty to act to safeguard girls at risk and practitioners must be aware of the need to do the following:

  • Always take the issue seriously and recognise the need to protect a girl from potentially significant harm. Many professionals may find it hard that a parent, for example, will arrange for FGM to be committed on their daughter and have her sent abroad for that purpose. Depending on the cultural practice, young girls may be told by their parents that it is a special procedure that will enable them to become a woman;
  • See the girl on their own in a private place where the conversation cannot be overheard or seen by the person acting on their behalf;
  • Gather as much information as possible about the potential victim or victim, it may be the only opportunity;
  • Remind the potential victim or victims of their rights, i.e. that FGM is illegal in the UK and that FGM is, depending on the age of the girl, considered to be child abuse; and
  • Discuss the case with other relevant agencies. For example, if a girl has already been subjected to FGM, then the police should be informed that an illegal act has been committed.

Do not:

  • Send the girl or person acting on her behalf away and dismiss the allegation that FGM could be committed on the basis of little evidence;
  • Inform the girl’s family, friends or members of the community that she has sought help; or
  • Attempt to mediate.


7. FGM Protection Order Applications

Applications for a FGM Protection Order made by a Local Authority should be made via its legal department, in close liaison with the relevant frontline practitioner. Caseworkers and social workers should not pursue an application themselves. All the relevant information about making an application for a FGM Protection Order is contained in HM Courts & Tribunals Service leaflet FGM700. The application itself is made on Form FGM001. This form enables an application to be made by a relevant third party and to include background information (i.e. evidence in support of the application). Links to all the court forms are listed at the end of this procedure.

Once a FGM Protection Order is in place, it is essential that local authorities work closely with the victim and the relevant support service if there is one, to ensure it offers the level of protection that was envisaged.

If an FGM Protection Order is breached, it can either be dealt with in the Family Court (as contempt of court proceedings) or in a criminal court (as a criminal matter). If the police investigate a possible breach as a criminal offence, they can arrest those suspected of breaching the terms of the order. Following a police investigation, the Crown Prosecution Service will decide whether to proceed with a prosecution for the breach and / or any other offences that might be disclosed. Where the decision is taken, however, to pursue breach as a contempt of court matter, an application should be made to the Family Court for an arrest warrant. This should be supported by a statement setting out how the order has been breached. The order will need to be served on the respondents.


8. Responding to Female Genital Mutilation - the Role of Health

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 Female Genital Mutilation (FGM). All girls and women who have undergone FGM should be given information about the legal and health implications of practicing.

Health 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.

Health visitors are in a good position to reinforce information about the health consequences and the law relating to FGM. Currently, FGM is not always provided on post-natal discharge reports and is not recorded routinely in health visiting records. Health visitors should seek to record this information.

If a girl or woman who has been de-infibulated requests re-infibulation after the birth of a child, where the child is female or there are daughters in the family, health professionals should consult with their designated child protection adviser and with  Children’s Social Care about making a referral to them.

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. This is because, whilst the request for re-infibulation is not in itself a child protection issue, the fact that the girl or woman is apparently not wanting 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 the named designated safeguarding professional and with  Children’s Social Care about making a referral to them.

If the girl or woman is a carer for female children, a mother or prospective mother, her child/ren or unborn child should be considered vulnerable.  Risk can only be considered at a particular moment in time and therefore Healthcare professionals should take the opportunity to continue their discussions around FGM throughout the standard delivery of Healthcare. Professionals should discuss and seek advice throughout this time from their named designated safeguarding professional.

Any information or concern that a child is at immediate risk of or has gone undergone FGM should result in a child protection referral to Children’s Social Care in line with the Referrals Procedure.

Service Support – Interpreters:

Care must be taken to ensure that an interpreter is available, as this will be required in many appointments relating to FGM. The interpreter should be an authorised accredited interpreter and should not be a family member, not be known to the individual and not be an individual with influence in the individual’s community.

Observing the partner or a family member, if either are present, during the consultation:

If a woman or child is accompanied by a partner/relative/guardian respectively, the health and social care professional must be vigilant and aware of the signs of coercion.

NHS Actions

Since April 2014 NHS hospitals have been required to record:

  • If a patient has had Female Genital Mutilation;
  • If there is a family history of Female Genital Mutilation;
  • If a Female Genital Mutilation-related procedure has been carried out on a patient.


9. Mandatory Reporting of FGM to the Police

The FGM mandatory reporting duty is a legal duty provided for in the FGM Act 2003 (as amended by the Serious Crime Act 2015). The legislation requires regulated health and social care professionals and teachers in England and Wales to make a report to the police where, in the course of their professional duties, they either:

  • Are informed by a girl under 18 that an act of FGM has been carried out on her; or
  • Observe physical signs which appear to show that an act of FGM has been carried out on a girl under 18 and they have no reason to believe that the act was necessary for the girl’s physical or mental health or for purposes connected with labour or birth.

For the purposes of the duty, the relevant age is the girl’s age at the time of the disclosure / identification of FGM (i.e. it does not apply where a woman aged 18 or over discloses she had FGM when she was under 18).

Visually identified cases – when you might see FGM

For healthcare professionals, if, in the course of your work, you see physical signs which you think appear to show that a child has had FGM, this is the point at which the duty applies – the duty does not require there to be a full clinical diagnosis confirming FGM before a report is made, and one should not be carried out unless you identify the case as part of an examination already under way and are able to ascertain this as part of that. Unless you are already delivering care which includes a genital examination, you should not carry one out.

For teachers and social workers, there are no circumstances in which you should be examining a girl. It is possible that a teacher, perhaps assisting a young child in the toilet or changing a nappy, may see something which appears to show that FGM may have taken place. In such circumstances, the teacher must make a report under the duty, but should not conduct any further examination of the child.

Verbally disclosed cases

If you are a relevant professional and a girl discloses to you that she has had FGM (whether she uses the term ‘female genital mutilation’ or any other term or description, e.g. ‘cut’) then the duty applies. If, in the course of delivering safe and appropriate care to a girl you would usually ask if she has had FGM, you should continue to do so.

The duty applies to cases directly disclosed by the victim; if a parent, guardian, sibling or other individual discloses that a girl under 18 has had FGM, the duty does not apply and a report to the police is not mandatory.

Timeframe for reports

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.

A longer timeframe than the next working day may be appropriate in exceptional cases where, for example, a professional has concerns that a report to the police is likely to result in an immediate safeguarding risk to the child (or another child, e.g. a sibling) and considers that consultation with colleagues or other agencies is necessary prior to the report being made. If you think you are dealing with such a case, you are strongly advised to consult colleagues, including your designated safeguarding lead, as soon as practicable, and to keep a record of any decisions made. It is important to remember that the safety of the girl is the priority.

Making a report

Where you become aware of a case, the legislation requires you to make a report to the police force area within which the girl resides. The legislation allows for reports to be made orally or in writing.

When you make a report to the police, the legislation requires you to identify the girl and explain why the report is being made. While the requirement to notify the police of this information is mandatory and overrides any restriction on disclosure which might otherwise apply, in handling and sharing information in all other contexts you should continue to have regard to relevant legislation and guidance, including the Data Protection Act 1998 and any guidance for your profession. The provisions of the Data Protection Act 1998 do not prevent a mandatory report to the police from being made.

It is recommended that you make a report orally by calling 101, the single non-emergency number.

When you call 101, the system will determine your location and connect you to the police force covering that area. You will hear a recorded message announcing the police force you are being connected to. You will then be given a choice of which force to be connected to – if you are calling with a report relating to an area outside the force area which you are calling from, you can ask to be directed to that force.

Calls to 101 are answered by trained police officers and staff in the control room of the local police force. The call handler will log the call and refer it to the relevant team within the force, who will call you back to ask for additional information and discuss the case in more detail. In Hertfordshire there are two dedicated FGM trained Police Officers who would be involved in any investigation.

You should be prepared to provide the call handler with the following information:

Explain that you are making a report under the FGM mandatory reporting duty.

  • Your details:
    • Name;
    • Contact details (work telephone number and e-mail address) and times when you will be available to be called back;
    • Role;
    • Place of work.
  • Details of your organisation’s designated safeguarding lead:
    • Name;
    • Contact details (work telephone number and e-mail address);
    • Place of work.
  • The girl’s details:
    • Name;
    • Age/date of birth;
    • Address.
  • If applicable, confirm that you have undertaken, or will undertake, safeguarding actions, as required by the English or Welsh version of Working Together to Safeguard Children as appropriate.

You will be given a reference number for the call and should ensure that you document this in your records

Record keeping

Throughout the process, you should ensure that you keep a comprehensive record of any discussions held and subsequent decisions made, in line with standard safeguarding practice. This will include the circumstances surrounding the initial identification or disclosure of FGM, details of any safeguarding actions which were taken, and when and how you reported the case to the police (including the case reference number).

Informing the child’s family

In line with safeguarding best practice, you should contact the girl and/or her parents or guardians as appropriate to explain the report, why it is being made, and what it means. Wherever possible, you should have this discussion in advance of/in parallel to the report being made.


10. Reducing the Prevalence of Female Genital Mutilation

Local Safeguarding Children Boards should promote awareness in the local area, particularly amongst local communities which practice FGM, that female genital mutilation is abusive to children and not legal in the UK.

See the Local Authority Social Services Letter LASSL (2004) for details of organisations able to advise on this form of community outreach work.

Useful contacts are:

  • Foundation for Women's Health, Research & Development, 6th Floor, 50 Eastbourne Terrace, London W2 6LX, Tel. 0207 725 2606;
  • Forward Safeguarding Rights and Dignity website;
  • The African Well Woman Clinic at Central Middlesex Hospital, Acton Lane, Park Royal, NW10 7NS.

Further Information

For further information on FGM please see below:

Ministry of Justice

Jean McMahon
Criminal and Civil Law Policy Unit

Jean.McMahon@justice.gov.uk

Telephone: 0203 334 3208

Tribunals Service Forms

FGM001
Application form for FGM Protection Order

FGM002
Notice of Proceedings for a FGM Protection Order

FGM003
Application to vary, extend or discharge FGM Protection Order
hmctsformfinder.justice.gov.uk
Multi-Agency Practice Guidelines The current guidance is available at the weblink shown in the column opposite. However, this guidance is being updated (anticipated to be available later this year). Female Genital Mutilation: Guidelines to Protect Children and Women Guidance (GOV.UK)
Legislation

Female Genital Mutilation Act 2003

Section 73, Serious Crime Act 2015

Explanatory notes to Serious Crime Act 2015 (section 73)

Female Genital Mutilation Act 2003

Section 73, Serious Crime Act 2015

Explanatory notes to Serious Crime Act 2015

Government website   Female Genital Mutilation: help and advice website (GOV.UK)
NSPCC Contact the NSPCC anonymously if you're worried that a girl or young woman is at risk of FGM or is a victim of FGM.

FGM Helpline

Email: fgmhelp@nspcc.org.uk

Telephone: 0800 028 3550
Find out about call charges
BMA Guidance: FGM Caring for patients and child protection The guidance is currently under review to take into account recent legislative and policy developments. New guidance is due for publication summer 2015.  
Department of Health Guidance: Female Genital Mutilation Risk and Safeguarding; Guidance for professionals   Female Genital Mutilation Risk and Safeguarding: Guidance for professionals (March 2015)

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