Female Genital Mutilation (FGM) is child abuse and a form of violence against girls and women, as well as being a violation of human rights.  It comprises all procedures involving partial or total removal of the external genitalia or other injury to the female genital organs for non-medical reasons.  At least 200 million girls and women have undergone some form for FGM and over 3,000 girls and women in the City of London and Hackney are living within the consequences of FGM.

FGM is practised by families and communities for a variety of complex reasons but often in the belief that it is beneficial for the girl or woman.  However, it has no health benefits and cause harms to girls and women in many ways.

The age at which girls undergo FGM varies enormously according to different communities. The procedure may be carried out when a girl is newborn, during childhood or adolescence, just before marriage or during the first pregnancy. However, the majority of cases of FGM are thought to take place between the ages of 5 and 8 and therefore girls within that age bracket are at a higher risk.

Consequences of FGM

FGM involves removing and damaging healthy and normal female genital tissues, and hence interferes with the natural function of female bodies. The practice causes severe pain and has several immediate and long-term health as well as psychological consequences, including difficulties in childbirth also causing dangers to the child.

The list below shows some of the short term and long consequences arising from FGM:

– Severe pain

– Urinary and wound infections (such as Hepatitis B)

– Excessive bleeding · Fractures or dislocation

– Difficulties menstruating

– Renal failure

– Damage to reproductive system

– Complications in pregnancy and child birth

– Emotional and psychological issues which may lead to long term mental health problems

– Difficulties with personal and family relationships

– Death

FGM related legislation

FGM is illegal. Under the FGM Act 2003, a person is guilty of an offence if they excise, infibulate or otherwise mutilate the whole or any part of a girl’s or woman’s labia majora, labia minora or clitoris, except for necessary operations performed by a registered medical professional on physical and mental health grounds.

It is also an offence to assist a girl to perform FGM on herself. Any person found guilty of an offence under the Act will be liable to a maximum penalty of 14 years imprisonment or/and a fine.

The Serious Crime Act 2015 also brought in a number of other changes:

– Duty to notify the police of FGM (mandatory reporting): This section places a duty on those who work in ‘regulated professions’ namely healthcare professionals, teachers and social care workers, to notify the police when, in the course of their work, they discover that an act of FGM appears to have been carried out on a girl who is under 18. Failing to comply with the duty will be dealt with via existing disciplinary measures, which may include referral to the professional regulator and/or Disclosure and Barring Service as appropriate. This duty is effective from 31st October 2015. Further guidance on the mandatory reporting duty can be found in the Home Office guidance Mandatory Reporting for FGM procedures. The mandatory reporting Factsheet produced by the Department of Health provides additional information for mandate reporters.

– Anonymity for victims: lifelong anonymity for alleged victims of FGM. The aim here is to increase reporting of FGM by encouraging victims to report FGM offences and to increase prosecutions by helping the victim feel safe in their anonymity if they report a crime against them.

– Duty to protect a girl: there is a new offence of failing to protect a girl under the age of 16 from FGM. A person is liable if they are ‘responsible’ (possess parental responsibility) for a girl or have assumed responsibility for caring for a girl at the time when the offence is committed against her (this can include a Local Authority who has parental responsibility). · FGM Protection Orders: the high court or family courts will be able to make a protection order, which can be used to protect a girl who may be at risk of an FGM offence or a girl to whom FGM has been committed. It will be a criminal offence to breach the order and the penalty will be a maximum penalty of five years imprisonment or as a civil breach punishable by up to two years’ imprisonment.

For more information on FGM related legislation read the Home Office Factsheet.

Relevant guidance

For professionals working in Hackney and/or the City of London, please refer to the City and Hackney multi-agency FGM protocol found on the protocols, guidance and procedures section

The Government issued Statutory Guidance in April 2016 for frontline professionals who have responsibilities to safeguard children and young people; and to protect and support adults from the abuses associated with FGM.

The FGM Resource Pack is the national repository for all information and resources on FGM. It includes information on legislation, guidance, support services available, videos, case studies and an e-learning tool.

The London Safeguarding Children Board has also developed the London FGM Resource Pack which provides further guidance to professionals, volunteers and individuals.

The Female Genital Mutilation Helpline is a UK-wide service. It operates 24/7, and is staffed by specially trained child protection helpline counsellors who can offer advice, information, and assistance. 0800 028 3550 or contact by email fgmhelp@nspcc.org.uk.

Further information on FGM is available at the following websites:

Signs of FGM

Below are some of the signs which may indicate that someone has undergone or is at risk of FGM. Many of these signs have been adapted from the multi-agency statutory guidance on female genital mutilation. [2] This is not an exhaustive list and there may be additional signs/factors to help identify the risk level of FGM.

A girl or women who has been subjected to the FGM may:

– Have frequent urinary, menstrual and/or stomach problems

– have difficulty in walking, sitting or standing or looks uncomfortable

– spend longer in the bathroom or toilet due to difficulties urinating and menstrual problems

– avoid physical exercise

– have prolonged or repeated absences, such as from school

– have increased emotional and psychological needs

– be reluctant to undergo any medical examinations

– ask for help, but not explicit about the problem

– talk about pain or discomfort between her legs

There are a number of factors which may indicate whether a girl or woman is at risk of FGM, these include:

– a female child is born to a woman who has undergone FGM

– an older sibling or cousin of the girl has already undergone FGM

– the father of the girl or woman comes from a community known to practice FGM

– the women marries into community known to practice FGM

– the family indicate that there are strong levels of influence held by elders and/or elders are involved in bringing up female children

– family members believe FGM is integral to cultural or religious identity

– the family has limited level of integration with other communities in the UK

– the parents have limited access to information about FGM and do not know about the harmful effects of FGM or UK law.

– a girl or woman confides to a professional that she is to have a ‘special procedure’ or to attend a special occasion to ‘become a woman’

– a girl talks about a long holiday to her country of origin or another country where the practice is prevalent

– parents state they or a relative will take the girl out of the country for a prolonged period

– a parent or family member expresses concerns that FGM may be carried out

– family members are not engaging with professionals (such as in health and education)

– a family is already known to social care in relation to other safeguarding issues

– a girl requests help from a teacher or another adult because she is aware or suspects that she is at immediate risk of FGM

– a girl talks about FGM in conversation, for example, a girl may tell other children about it. It is important the context of the discussion is taken into account

– a girl is withdrawn from Personal, Social, Health and Economic (PSHE) education

– a girl is unexpectedly absent from school

– sections are missing from a girl’s Red Book

– a girl has attended a travel clinic or equivalent for vaccinations/anti-malarials