FGM is the injury of, or partial/total removal of the external female genitalia or female genital organs for non-medical reasons. It is estimated that more than three million females are at risk of FGM annually.
The victims of FGM are girls from infancy to adolescents, and occasionally adult women. The practice is recognised internationally as a violation of human rights and reflects an inequality and discrimination against women and girls.
FGM is often thought as a practice not affecting girls in England and is normally associated with African countries. However, NHS statistics covering the period of April 2016 to March 2017 reveal that there were over 9,000 cases where FGM was identified, 5,391 of which were newly recorded cases. Young girls are often taken abroad for FGM, especially in the summer holidays so that they have time to ‘heal’ from the procedure before they return to school.
FGM has been illegal in the United Kingdom since 1985 but the law was strengthened with the Female Genital Mutilation Act 2003, making it a criminal offence for UK nationals to perform or arrange FGM overseas. It also increased the maximum prison sentence from 5 to 14 years and allowed FGM victims to obtain anonymity from the date the allegation is made to last for the victim’s whole life. Under this newer legislation any person responsible for a child who fails to protect them from FGM can be imprisoned for up to 7 years.
FGM does not provide any health benefits; it only harms women and girls and it disrupts the natural functions of female bodies. It can cause:
- severe pain
- excessive bleeding (haemorrhage)
- genital tissue swelling
- infections e.g. tetanus
- urinary problems
- wound healing problems
- injury to surrounding genital tissue
Long-term complications can include:
- urinary problems (painful urination, urinary tract infections)
- vaginal problems (discharge, itching, bacterial vaginosis and other infections)
- menstrual problems (painful menstruations, difficulty in passing menstrual blood)
- scar tissue and keloid
- sexual problems (pain during intercourse, decreased satisfaction)
- increased risk of childbirth complications (difficult delivery, excessive bleeding, caesarean section, need to resuscitate the baby) and new-born deaths
- need for later surgeries; for example, the sealing or narrowing of the vaginal opening may lead to the practice of cutting open the sealed vagina later to allow for sexual intercourse and childbirth (known as deinfibulation). Sometimes genital tissue is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing both immediate and long-term risks.
- psychological problems (depression, anxiety, post-traumatic stress disorder, low self-esteem)
The practice is mainly concentrated in the Western, Eastern, and North-Eastern regions of Africa, some countries in the Middle East and Asia, as well as among migrants from these areas. FGM is therefore a global concern.
There is a misguided belief that FGM occurs due to specific religions, but this is not accurate. It is not recommended by any religion but has, supposedly, become a symbolic demonstration of faith in certain communities.
FGM mainly occurs because of a mixture of sociocultural factors within communities. It is mostly forced upon young girls because their family and community strongly believe that it is necessary and it is seen as a rite of passage; there is, however no religious reason that supports the practice of FGM and it is essentially about the control of women and girls.
What to do if you think someone is at risk of FGM
It is essential to act quickly that if you think someone is at risk of FGM. You should also consider any female siblings or extended family members who may be at risk.
Some risk indicators may include:
- the family comes from a community known to practice FGM
- parents requesting permission for their child to be taken out of school two weeks before or after the summer holidays (recovery period can be up to 8-10 weeks)
- a person talking about a long holiday to her country of origin or another country where the practice is prevalent
- a child talking about ‘becoming a woman’ or ‘rites of passage’
- a child talking about new clothing or special outfits
- a child may confide in a professional that they are about to undergo a “special procedure” or attend a special occasion
- a child becoming withdrawn or acting out of character
- there are older females in the family (e.g. older sister/s, mother) who have undergone FGM
- a child whose mother has undergone the procedure
- a girl whose sister/s have undergone the procedure
Some indicators that FGM has taken place include:
- a child who has frequent urinary or menstrual issues.
- frequent absences from school
- changes in the child’s behaviour when they return from a long “holiday”
- a child refusing to attend exercise classes at school, often citing her faith as a reason.
How to respond to a child or young person at risk of, or who has experienced FGM
- You must follow safeguarding procedures to provide the immediate protection and support for the young person and other potential victims within the immediate and extended family.
- If possible, see the person on their own, allowing them the opportunity and a space to disclose.
- Be straightforward with the questions, using questions that are understandable and straightforward
- Remember that the person who did this to them may be someone they love or respect; they may feel a loyalty to that person, they may also not be aware what has happened to them is against the law.
- Be aware of barriers such as language and cultural differences If appropriate arrange for an interpreter. Where an interpreter is needed, a female interpreter is essential; a family or community member must not be used to translate
- Allow the person to go at their own speed, do not rush them
- Take accurate notes, being mindful of the urgency if they are at risk.
- Ensure they know how to contact you again
- Be sensitive about the intimate nature of what you are discussing
- Listen but do not make judgements; it is ok to condemn the act but not to blame the person
Reporting duty for all professionals who identify FGM
All professionals who, in the course of their work, believe that an act of FGM has been carried out on a person who is aged under 18 years must notify the police. This includes cases where:
- A child / young person has told a professional that an act of FGM (however described) has been carried out on them, or
- The professional has observed physical signs indicating female genital mutilation has been carried out and the professional has no reason to believe that the act was part of:
- a surgical operation on a female which is necessary for her physical or mental health, or
- a surgical operation on a female who is in any stage of labour, or has just given birth, for purposes connected with the labour or birth
The professional who identifies FGM must call 101 to make a report. When making an FGM notification to the police the professional must have details of:
- Person’s name, date of birth and address
- Name and contact details of the professional
- Name and contact details of the local Safeguarding Lead
It is best practice when making notifications to the police to ensure:
- the notification is made on the same the same working day as FGM was identified calling via 101 to make a report
- The Local safeguarding Lead within your organisation is updated within one day
- all decisions and actions taken are recorded
If you believe that the person is in immediate danger you must act immediately, which may include calling 999. Mandatory reporting is only one part of safeguarding against FGM.
If the woman is over 18 when she discloses/FGM is identified, the mandatory duty to report does not apply and you should follow local safeguarding adults procedures.
In all cases, professionals should also consider whether there are other people within the household, extended family and community who may be at risk of or may have been subject to FGM and whether anyone should be referred to the Children and Families Service. If the professional identifies an adult at risk of, or having been the subjected to FGM, local safeguarding adults procedures should be followed.