In June 2017, this chapter was updated with information about the four types of FGM as defined by WHO. Links have been added to both the new Home Office FGM protection orders factsheet and to the guidance to the 'Statement opposing female genital mutilation' (often referred to as a health passport).
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 makes it an offence for the first time for UK nationals or permanent 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.
The rights of women and girls are enshrined by various universal and regional instruments including the Universal Declaration of Human Rights, the United Nations Convention on the Elimination of all Forms of Discrimination Against Women, the Convention on the Rights of the Child, the African Charter on Human and Peoples' Rights and Protocol to the African Charter on Human and Peoples' Rights on the rights of women in Africa. All these documents highlight the right for girls and women to live free from gender discrimination, free from torture, to live in dignity and with bodily integrity.
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.
Suspicions may arise in a number of ways that a child is being prepared for FGM to take place abroad.
Consider whether any other indicators exist that FGM may have or has already taken place, for example:
- Preparations are being made to take a long holiday - arranging vaccinations or planning an absence from school;
- The child has changed in behaviour after a prolonged absence from school; or
- The child has health problems, particularly bladder or menstrual problems.
There may be older women in the family who have already had the procedure and this may prompt concern as to the potential risk of harm to other female children in the same family.
The Children's Social Care Services team will liaise with the Paediatric services where it is believed that FGM has already taken place to ensure that a Medical Assessment takes place by a Consultant Paediatrician experienced in examining children and young people who have been sexually abused, see Child Protection Enquiries Procedure, Medical Assessments.
It should be remembered that this will have lifelong consequences, and can be highly dangerous at the time of the procedure and directly afterwards.
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 see Mandatory Reporting of FGM.
Identification and Referral:
Early identification of risks of FGM to girls, referral, planned and sustained information and support to families are needed to protect girls from undergoing FGM.
Some professionals will have greater opportunities to identify girls at risk of FGM, these include General Practitioners, paediatricians, midwives, health visitors, school nurses, accident and emergency professionals, teachers and nursery staff. These may also include specific health settings such as sexual health clinics, sexual assault centres and community contraceptive services.
All NHS hospitals are required to record:
- If a patient has had Female Genital Mutilation;
- If there is a family history of Female Genital Mutilation;
- If a Female Genital Mutilation-related procedure has been carried out on a patient.
Since September 2014 all acute hospitals must report this data centrally to the Department of Health on a monthly basis. This is the first stage of a wider ranging programme of work in development to improve the way in which the NHS will respond to the health needs of girls and women who have undergone Female Genital Mutilation and actively support prevention.
For further information, see Information Standards Board for Health and Social Care Female Genital Mutilation Prevalence Dataset Specification.
Mandatory Reporting of FGM
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 which they identify in the course of their professional work to the police.
'Known' cases are those where either a girl informs the person that an act of FGM – however described – has been carried out on her, or where the person observes physical signs on a girl appearing to show that an act of FGM has been carried out and the person has no reason to believe that the act was, or was part of, a surgical operation within section 1(2)(a) or (b) of the FGM Act 2003.
The duty applies to known cases of FGM and therefore should fall within non urgent circumstances and be reported to the police by telephoning the non emergency number 101 as soon as possible (within 48 hours). In exceptional circumstances professionals can report up to one month. Should a child be discovered who has just been cut or there is an immediate risk to other children within the home, then an urgent telephone call should be made via 999. When contacting the police the professional should make it clear that they are making a report under the FGM mandatory reporting duty and provide the following information:
- Their name, contact details, role and place of work;
- Details of the designated safeguarding lead for their organisation;
- Details of the girl in question including name, age/date of birth and address;
- If applicable confirm that safeguarding actions have been undertaken or will be undertaken.
A failure to report the discovery in the course of their work could result in a referral to their professional body. The Home office has produced guidance Mandatory Reporting of Female Genital Mutilation – procedural information to support this duty
In cases where girls are identified as having undergone FGM a referral to children's social care and the Police must be made.
Women who have undergone FGM are more likely to be identified through maternity services. At booking maternity health professionals should enquire sensitively about FGM and once identified respond to the women's complex needs. These women should be given information on the law on FGM and support provided to women. All women who have undergone FGM and give birth to a female child are to be referred to Children's Services for discussion and review.
It is important to share this information with other appropriate health professionals.
Children's Social Care Services jointly with the Police will undertake a Section 47 Enquiry if it has reason to believe that a child is likely to suffer or has suffered FGM.
Where a child has been identified as at risk of significant harm, it may not always be appropriate to remove the child from an otherwise loving family environment. Parents and carers may genuinely believe that it is in the girl's best interest to conform to their prevailing custom.
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 an Emergency Protection Order or a Prohibited Steps Order, making it clear to the family that they will be breaking the law if they arrange for the child to have the procedure.
The 2003 Female Genital Mutilation Act makes it illegal for any residents of the UK to perform FGM within or outside the UK. The punishment for violating the 2003 Act carries 14 years imprisonment, a fine or both.
Where is FGM Practised?
As a result of immigration and refugee movements, FGM is now being practiced by ethnic minority populations in other parts of the world, such as USA, Canada, Europe, Australia and New Zealand. FORWARD estimates that as many as 6,500 girls are at risk of FGM within the UK every year.
There is no Biblical or Koranic justification for FGM and religious leaders from all faiths have spoken out against the practice.
Consequences of FGM
Depending on the degree of mutilation, FGM can have a number of short-term health implications:
- Severe pain and shock;
- Urine retention;
- Injury to adjacent tissues;
- Immediate fatal haemorrhaging.
Long-term implications can entail:
- Extensive damage of the external reproductive system;
- Uterus, vaginal and pelvic infections;
- Cysts and neuromas;
- Increased risk of Vesico Vaginal Fistula;
- Complications in pregnancy and child birth;
- Psychological damage;
- Sexual dysfunction;
- Difficulties in menstruation.
In addition to these health consequences there are considerable psycho-sexual, psychological and social consequences of FGM.
Justifications of FGM
The justifications given for the practise are multiple and reflect the ideological and historical situation of the societies in which it has developed. Reasons include:
- Custom and tradition;
- Religion, in the mistaken belief that it is a religious requirement;
- Preservation of virginity/chastity;
- Social acceptance, especially for marriage;
- Hygiene and cleanliness;
- Increasing sexual pleasure for the male;
- Family honour;
- A sense of belonging to the group and conversely the fear of social exclusion;
- Enhancing fertility.
The Female Genital Mutilation (FGM) Act was introduced in 2003 and came into effect in March 2004 and amended by the Serious Crime Act 2015:
- Makes it illegal to practice FGM in the UK;
- Makes it illegal to take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in that country;
- Makes it illegal to aid, abet, counsel or procure the carrying out of FGM abroad;
- Has a penalty of up to 14 years in prison and, or, a fine.
FGM Prevention online resources
There is a midwife with a specialist interest in FGM working at both City and Queens Medical Centre hospitals, who can be contacted for advice through their ante-natal clinics. Tel: 0115 9249924.
Tackling FGM in the UK – Intercollegiate recommendations for identifying, recording and reporting. Nov 2013 RCM
The Female Genital Mutilation Helpline - a 24/7 UK-wide service staffed by specially trained child protection helpline counsellors who can offer advice, information, and assistance to members of the public and to professionals. Counsellors will also be able to make referrals, as appropriate, to statutory agencies and other services.
The helpline can be contacted on:
Tel: 0800 028 3550 and E-mails sent to firstname.lastname@example.org.