What is FGM?
Female genital mutilation (FGM) is the partial or total removal of external female genitalia for non-medical reasons. The World Health Organisation (WHO) define it as:
“All procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons”.
FGM known by a variety of different terms including female circumcision, cutting or sunna. Religious, social or cultural reasons are sometimes given for FGM and it is usually carried out by traditional circumcisers, who often play other central roles in communities such as attending child births or in some countries, actually by health providers.
However … FGM is child abuse. It’s dangerous and a criminal offence (FGM Act 2003). There are no medical reasons to carry out FGM. It doesn’t enhance fertility and it doesn’t make childbirth safer. It is used to control female sexuality and can cause severe and long-lasting damage to physical and emotional health. There is a mandatory requirement on healthcare professionals, social workers and teachers to report cases of FGM in girls under 18 years of age.
What do we know?
The practice of FGM dates back at least 2000 years. The UK charity, Plan International, has revealed in early 2017 that every hour a victim of FGM is either discovered or treated at a medical appointment in England. Statistics from the charity showed there were almost 9,000 times when a girl or woman was assessed at a doctor’s surgery or hospital. Worldwide, it is estimated that 200 million women and girls are affected by FGM. These figures were released to raise awareness and mark the international day of zero tolerance to FGM which took place on February 7th. The charity analysed NHS figures from between April 2015 and March 2016, showing that a patient was assessed every 61 minutes. On average, among those who attended, a victim of FGM is newly identified every 92 minutes. This means that a woman or girl has had their case recorded by the NHS for the first time. It could be that they were cut years previously but it hadn’t come to the attention of medical professionals sooner. Detective Chief Inspector Leanne Pook commented: “Each application is carefully considered and brought only in cases where they are deemed to be at risk. We have one active FGM investigation ongoing at the moment, but the majority of our work in this area focuses on safeguarding referrals. “This means working in partnership with our colleagues in local authorities, health and education to share information and visit and support families with children deemed to be at risk of FGM.”
Is it always the same?
No – there are different types of FGM as classified by the WHO – Type 1 Clitoridectomy; Type 2 Excision; Type 3 Infibulation; and Type 4 – other e.g. stretched labia and each have different complications and consequences for the girl or young woman who has experienced it.
What can happen?
There are a number of different complications and consequences of FGM including severe bleeding, acute urine retention, infection, fever, septicaemia, infertility, sexual dysfunction, problems in childbirth, or failure to heal … and these are just the physical issues. FGM can also have a very negative impact on emotional, mental and social wellbeing. Sadly, the ultimate consequence is death.
The Role of Education
There is a specific role for education providers to play in both identifying girls that may be at risk of FGM and other harmful practices, but also through education, helping eradicate these forms of abuse in the UK. The FGM National Centre, a partnership between Barnardos and the Local Government Association (LGA), have produced a number of resources for schools.
The Centre also provides training for school staff which includes gaining an understanding of FGM and other harmful practices; overviewing existing legislation; gaining confidence in dealing with cases of suspected FGM, clarity on the role of school staff, including Head Teachers and Governors, reflection on where FGM fits within the curriculum, use of available resources and engaging the community, including parents. For more information, contact Rohma Ullah via Rohma.Ullah@barnardos.org.uk.
Resources and Useful Links
- The FGM National Centre have produced an on-line Assessment Tool for use by Social Workers who need to analyse the risk of FGM in specific cases that have been referred.
- The Home Office has produced an FGM Resource Pack. It is designed to highlight examples from areas where effective practice has been identified and to emphasise what works in fighting FGM. The resource pack was updated in November 2015 to reflect legislative changes, including the mandatory reporting duty for professionals and publication of new prevalence data. The pack also includes case studies where FGM has been experienced by girls and women in the UK, information on what organisations can do to raise awareness of FGM in their local area and links to support organisations, clinics and helplines that can help people who think they might be at risk. NELFT have produced a leaflet for patients supporting their duty to report FGM in girls under 18.
- The Home Office, in conjunction with Virtual College, has also provided free online FGM training package that provides a useful introduction for practitioners in Social Care, Health, Education and Police. The course will help a wide range of multi-agency professionals to identify and assist girls who are at risk of FGM. For more information, please visit the Virtual College page here, or to sign up for the free training, please visit: www.fgmelearning.co.uk. It is recommended that front line practitioners attend face-to-face training which is available via the Redbridge SCP Training Programme.
- FORWARD (Foundation for Women’s Health Research and Development) is a leading African diaspora women’s campaign and support organisation committed to gender equality and safeguarding the rights of African girls and women. FORWARD’s focus is on FGM, child marriage and obstetric fistula.
- Trust for London – findings and evaluation of a six year initiative on working with community groups to eradicate FGM. Information includes a full report on the project, an evaluation summary, good practice guidance and views from those in communities affected by FGM.
- Training Films on YouTube for health professionals. These include hearing from women and girls that have been affected; basic training for healthcare assistants; guidance on mandatory reporting; and the effect of FGM on mental health.
- FGM Guidance and briefing PowerPoint for education professionals.
Local Specialist Clinics
There are three local clinics delivered by Barts NHS Health Trust that provide support to women and girls affected by genital mutilation. Women can self-refer or alternatively their GP, or hospital consultant can refer them. Details of the clinics are below.
- Chingway FGM Clinic, Chingway Medical Centre, 7 Ching Way, LONDON, E4 8YD. Appointments can be made via telephone (020 8430 7020) or via e-mail to firstname.lastname@example.org. Walk-ins are also accepted. This clinic takes place on Fridays, every two weeks from 20 September 2019, from 10:00 to 16:00.
- Whipps Cross Hospital FGM Walk-in Clinic for non-pregnant women, Perineal Clinic, Area A, Outpatients, Whipps Cross Hospital, Leytonstone, LONDON, E11 1NR. The clinic takes place on the last Monday of every month from 09:00 to 12:00.
- Whipps Cross Hospital FGM Clinic for pregnant women – held in the Antenatal Clinic, Maternity Building, Whipps Cross Hospital, Leytonstone, LONDON, E11, 1NR on the last Wednesday of every month from 14:00 to 17:00.
For general information on the clinics, the contact number is 020 8430 7020 or e-mail email@example.com
- FGM National Centre FGM Guidance
- FGM National Centre FGM Assessment Tool
- Female Genital Mutilation: The Facts
- Female Genital Mutilation Risk and Safeguarding: Guidance for Professionals
- National FGM Centre – Information to gather for a good referral for FGM
- HM Government – Multi-agency statutory guidance on female genital mutilation – updated 2020
- FGM Safeguarding and Risk Assessment – Quick guide for Health Professionals, DH, 2017
- FGM National Centre Global Map of Harmful Practices 2019
Local strategy, policies and procedures
- Redbrige LSCB FGM Strategy 2019 – 2021 [PDF 1MB)
- Redbridge LSCB Multi-Agency FGM Action Plan 2019 – 2021 (PDF 298KB)
- Redbridge LSCB Quick Learning Guide – Safeguarding Topic Sheet – Breast Ironing
- LSCB Culturagram – A tool to support professionals to consider culture and identity.
- LBR FGM Referral Pathway – Children’s Social Care (PDF 300KB)
The NSPCC provide a support service for members of the public and professionals to ask for help and advice relating to FGM. Telephone 0800 028 3550 or e-mail firstname.lastname@example.org.
Other Harmful Practices
FGM is just one of a number of harmful practices that exist both nationally and internationally. But what do we mean by the term ‘harmful practice’? Harmful practices are persistent practices and behaviours that are grounded on discrimination on the basis of sex, gender, age and often involve violence and cause physical and/or psychological harm or suffering. They are discriminatory, deny dignity, and violate human rights. Examples can include forced marriage, breast flattening, honour based violence, abuse linked to faith or belief, scarring or branding. Find out more on the FGM National Centre website.