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3.3.4 Female Genital Mutilation

SCOPE OF THIS CHAPTER

More information relating to this guidance can be found in the Cambridgeshire Local Safeguarding Children Board Procedures Manual.

Cambridgeshire Local Safeguarding Children Board Procedures Manual, Female Genital Mutilation Procedure

NSPCC Female genital mutilation (FGM) NSPCC factsheet

This chapter should be read in conjunction with the following:

Contacts and Referrals Procedure

This chapter was added to the manual in June 2014.


Contents

1. Definition
2. Types
3. Role of the Social Worker
  3.1 The role of the social worker (and other professionals) dealing with cases of FGM
  3.2 What social workers should be aware of and the procedures that should be implemented
  3.3 If FGM is Suspected
  3.4 Indicators that a girl may be at risk of FGM
  3.5 Indicators that may suggest a girl has already undergone FGM
  3.6 Sample questions that will help professionals when trying to identify whether a woman/girl has undergone FGM
  3.7 Possible problems for practitioners dealing with clients who have undergone FGM
  3.8 Achieving the best possible outcomes for the child
  3.9 Raising awareness of FGM
4. Glossary of Terms
5. References & Resources


1. Definition

The World Health Organisation (WHO) defines female genital mutilation 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)


2. Types

There are four different types of FGM, they include:

Type one: Also known as "clitoridectomy," - it is the partial or total removal of the clitoral and/or the prepuce.

Type two: Partial or total removal of clitoris and the labia minor, with or without the labia majora (excision).

Type three: Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minor and/or the labia majora, with or without excision of the clitoris (infibulation).

Type four: Unclassified

All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.

It is estimated that 130-140 million girls have undergone FGM worldwide and three million girls are at risk of undergoing FGM every year, which equates to over 8,000 girls every day. (WHO 2007).


3. Role of the Social Worker

3.1 The role of the social worker (and other professionals) dealing with cases of FGM

Is to:

  • Identify and refer FGM clients to appropriate agencies, as well as be able to identify children who are at risk;
  • Provide the best possible care for each woman or girl including her physical, emotional, psychosexual, cultural and social needs;
  • Be confident and competent in sharing information appropriately, both to safeguard children from being abused through FGM and to enable children and women who have been abused through FGM to receive physical, emotional and psychological help;
  • Discuss the health risks of FGM with the concerned family;
  • Provide good access to health care and continuous support;
  • Act as an advocate to increase professional and public awareness of FGM;
  • Work in partnership and form a network link with the practising communities, statutory and voluntary organisations;
  • Not encourage medicalisation – WHO’s policy guidelines state that nurses, midwives and other professionals must be expressly forbidden to perform FGM.

Professionals should be aware and informed, sensitive and not superior. They must assess individual needs and give relevant information in a language that the client understands; communication is very important and key to effective care. Women and girls should be cared for holistically and helped to alley anxiety.

3.2 What social workers should be aware of and the procedures that should be implemented

If a child or young adult is at risk of FGM, or has been referred to a social worker, this should be followed up in writing within 48 hours.

All necessary documents or records should be completed and relevant people should be informed e.g. the GP. The aim is to provide a therapeutic approach (safety and protection of children). The Early Help Assessment (EHA) may be a useful tool and can be requested by individuals or professionals if there are concerns about the child.

3.3 If FGM is Suspected

The following steps should be followed if FGM is suspected, and the child should be considered a child in need of protection:

  • Any information or concern should result in a child protection referral;
  • FGM places a child at risk of significant harm and should therefore be investigated by social services and the police child abuse investigation team.

The police will follow their own standard operating procedures in relation to FGM referrals.

  • Consideration must be given to whether siblings are at similar risk;
  • FGM referrals should be initially dealt with as section 47 enquiries;
  • A strategy meeting should be convened within two working days;
  • The chair of the meeting must be trained in FGM or be a child protection advisor;
  • The person that makes the referral must be invited to attend the meeting, as well as health or voluntary organisation with specific expertise in FGM;
  • A trained female interpreter should be used, if necessary, to gather information, and clarify issues and family attitudes.

The aim is to prevent a child undergoing any form of FGM, rather than remove the child from the family, and every attempt should be made to work with parent.

School teachers and school nurses have a key role to play in safeguarding children who are at risk of FGM, and should be aware of professional guidelines and referral systems available to help support families.

3.4 Indicators that a girl may be at risk of FGM

Include:

  • The child’s mother has undergone FGM;
  • The family is from a practising community, especially with an older female relative in the household;
  • A long holiday has been planned to the family’s country of origin or somewhere else where FGM is prevalent. (LSCB 2007).

3.5 Indicators that may suggest a girl has already undergone FGM

  • Prolonged absences from school;
  • A girl spending long periods outside the classroom with bladder or menstrual problems;
  • Change in attitude/behaviour, withdrawal or signs of depression;
  • A child repeatedly being excused from physical exercise. (LSCB 2007)

3.6 Sample questions that will help professionals when trying to identify whether a woman/girl has undergone FGM

  • I am aware that in some African countries and the Middle East women are circumcised, have you been through this procedure?
  • Have you been circumcised or closed?
  • Do you experience any problems passing urine or does it take you a long time to pass urine?
  • Do you experience any pain with menstruation?

3.7 Possible problems for practitioners dealing with clients who have undergone FGM

  • Practitioners may have a lack of knowledge and awareness of FGM;
  • Practitioners may only be able to find little or no accurate data on FGM;
  • There may be a language and communication barrier between practitioners and clients.

‘The basic requirement that children are kept safe is universal and cuts across cultural boundaries. Every child living in the UK is entitled to be given protection of the law, regardless of his or her background. Cultural heritage is important to many people, but it cannot take precedence over standards of childcare embodied in law’ (Lord Laming - The Victoria Climbie Inquiry, 2003).

3.8 Achieving the best possible outcomes for the child

This can be achieved by engaging and working closely with the practising communities; mobilising and helping them to change their attitudes and long held beliefs.

3.9 Raising awareness of FGM

  • Ensure that all professionals are aware of FGM and its complications;
  • A non-judgmental and sensitive approach should be taken.

Legal information and leaflets should be given to the families and communities. See NSPCC Female genital mutilation (FGM) NSPCC factsheet.

N.B. The Summer holiday is a key time when children and young adults are being taken on ‘holidays’ with the intention being for them to undergo FGM.

Practitioners must look beyond their natural instinct to be repulsed by the harmful practice of FGM. To look at the procedure itself in isolation is to completely misunderstand the social, cultural, ethnic, political and economic factors that affect attitudes of those who perpetuate FGM. It is important for those hoping to facilitate changes in attitude of those maintaining the practice of FGM to understand that use of judgemental language is unhelpful, as the result will be polarisation of the very community.


4. Glossary of Terms

  • Female Genital Mutilation is sometimes called female circumcision or female cutting;
  • Type 1, Female Genital Mutilation may be known to some communities as ‘Sunna’. Sunna is an Islamic word used to describe an action by the Prophet Mohammed;
  • Infibulation is derived from the name given to the Roman practice of fastening a ‘fibular’ or ‘clasp’ through the large lips of a female genitalia (usually within marriage) in order to prevent illicit sexual intercourse;
  • De-infibulation is the name for having FGM reversed and opening the entry to the vagina again;
  • Re-infibulation is the term used when women seek to be restored to their previous state usually following child birth;
  • The term “closed” refers to type 3 Female Genital Mutilation where there is a long scar covering the vaginal opening. This term is particularly understood by the Somali and Sudanese communities.


5. References & Resources

Female Genital Mutilation: Treating the Tears, Haseena Lockhat, 2004

Female Genital Mutilation, Comfort Momoh, 2005

Female Genital Mutilation Bill 2003

Human Rights Act (1998)

The Children Act. (1989) and the Children Act 2004

The Criminal Justice (Terrorism and Conspiracy) Act 1988

Webb E, Hartley B. (1994) Female Genital Mutilation: a dilemma in child protection. Archives of the Diseases of Childhood 70: 441-444

Working Together to Safeguard Children – A guide to inter-agency working to safeguard and promote the Welfare of Children. DOH (2015)

World Health Organisation, estimated prevalence rates of Female Genital Mutilation updated May 2001

United Nations Convention on the Rights of the Child (1989)

Resources for health professionals

British Medical Association. Doctor's responsibilities in child protection cases. London: BMA, 2004

Mwangi-Powell F (ed). Female genital mutilation: Holistic care for women. A practical guide for midwives. London: FORWARD, 2001

FGM Royal College of Nursing Educational Resource for Nursing and Midwifery Staff 2006

Royal College of Midwives. Female genital mutilation (female circumcision). Position paper no. 21. London: Royal College of Midwives, 1998

Royal College of Obstetricians and Gynaecologists. Setting Standards to improve women’s health, Female genital Mutilation, Statement No 3 May 2003

Royal College of Obstetricians and Gynaecologists. Female Circumcision (Female Genital Mutilation), June 1997

Hedley R, Dorkenoo E. Child protection and female genital mutilation: Advice for health, education, and social work professionals. London: FORWARD, 1992

Toubia N. Caring for women with circumcision: A technical manual for health care providers. New York: Rainbow, 1999

World Health Organisation, 1997, Management of Pregnancy, Childbirth and the Postpartum Period, Report of a WHO Technical Consultation Geneva, 15-17 October 1997

American College of Obstetricians and Gynaecologists. Female circumcision/female genital mutilation: Clinical management of circumcised women. Washington, DC: ACOG, 1999

FORWARD Another form of abuse London: FORWARD, 1992. This video, produced by FORWARD with funding from the Department of Health, gives a general introduction to female genital mutilation and its health implications. It also includes an interview with a woman who had genital mutilation performed on her.

Agencies offering help and advice, and who may be able to put enquirers in contact with local women’s groups

Foundation for Women’s Research and Development (FORWARD)

Unit 4
765-767 Harrow Rd
London NW10 5NY
Tel: 020 8960 4000
Fax: 020 8960 4014
Email: forward@forwarduk.org.uk
Internet: Forward website

International Planned Parenthood Federation

Regent’s College
Inner Circle
Regent’s Park
London NW1 4NS
Tel: 020 7487 7900
Fax: 020 7487 7897
Email: info@ippf.org
Internet: IPPF website

Black Women’s Health and Family Support (BWHAFS)

82 Russia Lane
London E2 9LU
Tel: 020 8980 3503
Fax: 020 8980 6314
Email: bwhafs@btconnect.com

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