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3.3.4 Female Genital Mutilation

This procedure must be read in conjunction with the LSCB procedure which gives more details of the background to FGM and the responsibilities of partner agencies including the mandatory duty on individual professionals to report it.

AMENDMENT

In May 2018 this chapter was extensively revised and updated and should be re-read in full.


Contents

  1. Definition
  2. Indicators
  3. The Role of Social Care


1. Definition

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 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 made it an offence for UK nationals, permanent or habitual 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.

FGM has been classified by the World Health Organisation (WHO) into four types:

  • Type 1 - Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris);
  • Type 2 - Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are the ‘lips’ that surround the vagina);
  • Type 3 - Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris; and
  • Type 4 - Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterising the genital area.

For more detail, please refer to the multi-agency statutory guidance - Multi–agency Statutory Guidance on Female Genital Mutilation April 2016.

Click here to access the GOV.UK website for Female Genital Mutilation.


2. Indicators

These indicators are not exhaustive and whilst the factors detailed below may be an indication that a child is facing / at risk of FGM, it must not be assumed simply on the basis of someone presenting with one or more of these warning signs. These 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 a 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 practiced 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 taking a more active / influential role in the family;
  • The family makes preparations for the child to take a holiday, e.g. arranging vaccinations, planning an absence from school;
  • The child talks about a ‘special procedure’ or ‘ceremony’ that is going to take place;
  • 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, including cervical smears;
  • 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, 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;
  3. The child has difficulty walking, sitting or standing and may appear to be uncomfortable.

It should not be assumed that families from practising communities will want their girls and women to undergo FGM.

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.

From the 31st October 2015, regulated professionals in health and social care and teachers in England and Wales have a duty to report ‘known’ cases of FGM in under 18s to the Police.

Professionals must take into consideration that 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 contact MASH to discuss their concerns whilst taking steps to minimise this risk.


3. The Role of Social Care

The following steps should be followed if FGM is suspected. The child should be considered a child in need of protection as there is a potential risk of significant harm

  • FGM referrals must always be managed as section 47 enquiries;
  • A strategy meeting must be convened within two working days;
  • The chair of the strategy meeting must have a good understanding of FGM, or have access to advice from someone with such knowledge/experience.
  • The person that makes the referral must be invited to attend the meeting, as well as Health and/or a voluntary organisation (if available and appropriate) with specific expertise in FGM;
  • Consideration must be given to whether siblings are at similar risk;
  • Where a child appears to be in immediate danger of mutilation, legal advice should be sought and consideration should be given, for example, to seeking a Female Genital Mutilation Protection Order, an Emergency Protection Order or a Child Arrangements Order, whilst making it clear to the family that they would be breaking the law if they arrange for the child to have the procedure.
  • In addition to following the Strategy Discussion Guidance, the following issues must be considered:
  • Seek maximum information about the specific cultural perspective of the family, including the attitudes towards, and history with FGM of family members
  • Explore whether the young person has a safe and trusted adult within the family or community
  • Consider the risk of flight and the possibility of the child being removed from the jurisdiction
  • Consider the potential for future harm as well as immediate protection
  • Plan in detail how the issues are to be discussed with the family, including timing and ensuring the safety of the child
  • Consider the respective roles of Heath, Police, Social care and others in progressing any plan
  • A trained female interpreter should be used, if necessary, to gather information and clarify issues and family attitudes.
  • A review strategy meeting will be held following contact with the family to review risk levels and decide on future actions, including possible legal action if required.

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

End