16.25 Female Genital Mutilation

Female genital mutilation 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.

This practice is not required by any major religion and medical evidence indicates that female genital mutilation causes harm to those who are subjected to it.

Girls may be circumcised or genitally mutilated illegally by doctors or traditional health workers in the UK, or sent abroad for the operation.

Female circumcision, excision or infibulation (female genital mutilation) is illegal in this country by the Female Genital Mutilation Act 2003, except on specific physical and mental health grounds.

It is an offence to:

• Undertake the operation (except in specific physical or mental health grounds);
• Assist a girl to mutilate her own genitalia;
• Assist a non-UK person to undertake female genital mutilation of a UK national outside the UK (except in specific physical or mental health grounds);
• Assist a UK national or permanent UK resident to undertake female genital mutilation of a UK national outside the UK (except in specific physical or mental health grounds).

The FGM mandatory reporting duty is a legal duty provided for in the FGM Act 2003 and 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 on the single non-emergency number 101 when in the course of their 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 disclosure/identification (i.e. it does not apply where a woman aged 18 or over discloses she had FGM when she was under 18)

The duty does not apply if a relative/carer discloses that a child has undergone FGM however safeguarding guidance should be followed. See Section 8.15

The duty is a personal duty which cannot be delegated and it does not breach any confidentiality requirement.

The duty applies to cases you discover in the course of your professional work, if you do not currently undertake genital examinations in the course of delivering your job, then the duty does not change this. Most professionals will only visually identify FGM as a secondary result of undertaking another action. For example- a teacher who is assisting a child with toileting requirements.

The duty applies to all regulated health, teaching and social work professionals. For teachers this includes persons employed to carry out teaching work in schools and other institutions.

The safety of the girl is the priority, reports under the duty should be made as soon as possible and best practice is before close of the next working day. The Police service should be the one in which the child resides, ring 101 explain that you are making a report under the FGM mandatory reporting duty. You will be given a reference number for the call, ensure that you document this in your records.

The safety of the girl is the priority, reports under the duty should be made as soon as possible and best practice is before close of the next working day. The Police service should be the one in which the child resides, ring 101 explain that you are making a report under the FGM mandatory reporting duty. You will be given a reference number for the call, ensure that you document this in your records.

Where there is a risk to life or of serious immediate harm professionals should report the case immediately to Police, dialling 999 if appropriate.

Non-regulated practitioners under their safeguarding children responsibilities must take appropriate safeguarding action in relation to any identified or suspected case of FGM but do not have to follow the mandatory reporting duty.

For additional resources and guidance:-

Multi_Agency_Statutory_Guidance_on_FGM__-_FINAL.pdf

FGM_Mandatory_Reporting_-_procedural_information_nov16_FINAL.pdf

FGM_mandatory_reporting_Fact_sheet_Web.pdf

Many girls may not be aware that they may be at risk of undergoing FGM but suspicions may arise in a number of ways that a child is being prepared for FGM to take place abroad. These include knowing that the family belongs to a community in which FGM is practised and is making preparations for the child to take a holiday, arranging vaccinations or planning absence from school. The child may also talk about a 'special procedure/ceremony' that is going to take place.

Girls are at particular risk of FGM during school summer holidays as this is the time when families may take their children abroad for the procedure.

Any medical provision for a pregnant person who has themselves been the subject of female genital mutilation provides the opportunity for recognition of risk and preventative work with parents.

A child may be considered to be at risk if it is known that older girls in the family have been subject to the procedure. Prepubescent girls of 7 to 10 are the main subjects, though the practice has been reported amongst babies.

Possible indicators are similar to other forms of abuse, especially Sexual Abuse, including:

• Bleeding, discharge, urinary infections;
• Reluctance to receive medical attention or to participate in sporting activities;
• Prolonged absence from school, with noticeable behaviour change on return and long periods away from classes or other normal activities;
• Some children find it difficult to sit still in class and look uncomfortable or may complain of pain between their legs;
• Mentioning something somebody did to them that they are not allowed to talk about.

Any suspicion of intended or actual female genital mutilation must be referred to Children's Social Care, in accordance with the Making a Referral Procedure.

Children's Social Care must inform the Safeguarding Investigations Unit at the earliest opportunity and convene a Strategy Discussion within two working days if:

• There is suspicion that a girl or young woman, under the age of eighteen, is at risk of undergoing this procedure;
• It is believed that a girl or young woman is at risk of being sent abroad for that purpose; or
• There are indications that a girl or young woman has suffered mutilation or circumcision.

A Children's Social Care manager who has attended female genital mutilation training or a child protection adviser / senior manager should chair the Strategy Discussion. Health providers or voluntary organisations with specific expertise should be invited. Consideration may be given to inviting a legal adviser.

In planning any intervention it is important to consider the significance of cultural factors. Female genital mutilation is generally performed because of the significance it has in terms of cultural identity. Any intervention is more likely to be successful if it involves workers from, or with a detailed knowledge of, the community concerned.

If necessary, legal advice must be taken on the options which could be considered to protect a child. Under the Children Act 1989, possible legal proceedings could include a Prohibited Steps Order with or without a Supervision Order. Removal from home should be considered only as a last resort.

If the child has already suffered female genital mutilation, the meeting will need to consider carefully whether to continue enquiries or whether to assess the need for support services.

Female genital mutilation is a one-off event of Physical Abuse (albeit one that may have grave permanent sexual, physical, and emotional consequences), not an act of repeated abuse and organisational responses need to recognise this.

A second Strategy Discussion should take place within 10 working days of the first meeting, with the same chair. This meeting must evaluate the information collected in the enquiry and recommend whether a Child Protection Conference is necessary.

A girl who has already been genitally mutilated should not normally be the subject of a Child Protection Conference or subject to a Child Protection Plan unless additional protection concerns exist, though she should be offered counselling and medical help. Consideration must however be given to any other female siblings at risk.

A girl believed to be in danger of genital mutilation may be made the subject of a Child Protection Plan under the category of risk of Physical Abuse if the criteria are applicable including the need for the future protection of the child.

The main emphasis of work in cases of actual or threatened genital mutilation should be through education and persuasion. This approach will be reflected in the Child Protection Plan.

An appropriate response to a child 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 straightforward 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.

NHS hospitals are 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.

All acute hospitals must report this data centrally to the Department of Health on a monthly basis. This is the first stage of a wider ranging programme of work in development to improve the way in which the NHS will respond to the health needs of girls and women who have suffered Female Genital Mutilation and actively support prevention.

The FGM Prevalence Dataset Information Standard instructs all clinicians to record into clinical notes when FGM is identified, and what type it is. For further information see: Information Standards Board for Health and Social Care Female Genital Mutilation Prevalence Dataset Specification.

In order to make sensitive and informed professional judgements about the child's needs, it is important that professionals are sensitive to differing family patterns and lifestyles and to child-rearing patterns that vary across different racial, ethnic and cultural groups. At the same time they must be clear that child abuse cannot be condoned for religious or cultural reasons.

Agencies should work together to promote a better understanding of the damaging consequences to health (physical and psychological) of female genital mutilation.

Wherever possible the aim must be to work in partnership with parents and families to protect children through parents' awareness of the harm caused to the child.

Useful contacts are:

• Foundation for Women's Health, Research and Development, (FORWARD) Tel: 020 8960 4000;
• The African Well Woman Clinic at Central Middlesex Hospital, Acton Lane, Park Royal, NW10 7NS.
• National Crime Agency