The World Health Organisation (WHO) defines female genital mutilation (FGM) as all procedures that that involve partial or total removal of the genitalia or other injury to the female genital organs for non-medical reasons. FGM is recognised as a violation of human rights (WHO 2017)
In the UK, it is against the law to practice FGM or to support a child going overseas to have FGM carried out. Regulated health and social care professionals have a duty to report known cases of FGM (Home Office 2016).
There are four different types of FGM
Type 1: Clitoridectomy
Type 2: Excision
Type 3: Infibulation
Type 4: Other
There are no medical reasons to carry out FGM and several health implications can result following it including, difficulties in; urinating, mensuration and complications in birth. These will depend on the type of FGM experienced (National FGM Centre 2017)
- A girl is born to a woman who has undergone FGM
- Mother has requested re-infibulation following childbirth
- A girl has an older sibling or cousin who has undergone FGM
- One or both parents or elder family members consider FGM integral to their cultural or religious identity
- The family indicate that there are strong levels of influence held by pro-FGM elders who are involved in bringing up female children
- A girl from a practising community is withdrawn from PSHE and/or Sex and Relationship Education or its equivalent may be at risk as a result of her parents wishing to keep her uninformed about her body, FGM and her rights
Signs that FGM has occurred
- prolonged absence from schools
- frequent need to go to the toilet
- long break to urinate
- urinary tract infections
- noticeable behaviour change
- change of dress from tight to loose fitting clothing
- menstrual problems
- difficulty in sitting down comfortably
- complain about pain between their legs
- talk of something somebody did to them that they are not allowed to talk about
Health implications of FGM
- severe pain and shock
- broken limbs from being held down
- injury to adjacent tissues
- urine retention
- increased risk of HIV and AIDS
- uterus, vaginal and pelvic infections
- cysts and neuromas
- increased risk of fistula
- complications in childbirth
- depression and post-natal depression
- psychosexual problems
- pregnancy and child birth
- sexual dysfunction
- difficulties in menstruation
- trauma and flashbacks
'Justifications' for FGM
Many affected communities believe that FGM is a necessary custom to ensure that a girl is accepted within the community and eligible for marriage.
Families who practice FGM on girls usually see it as a way of safeguarding their future.
Other reasons include:
- perceived health benefits
- preservation of the girl’s virginity
- rite of passage into woman-hood
- status in the community
- protection of family honour
- perceived religious justifications There are no religions that advocate for FGM.
Cases of FGM occur across the world but the risk is greatest in communities with links to certain countries within; Africa, the Middle East and Asia (National FGM Centre 2017).
In England 2016/17 there were 9,179 reports of FGM or where a procedure for FGM was undertaken. The average age at attendance was 31 years. 95% of the women and girls first recorded in the data in 2016/17 had undergone FGM before they were 18 years old (NHS 2017).
In Suffolk 2016/17 there were 15 reported cases where FGM had previously taken place. The highest risk of reported FGM was associated with east Asian communities (NHS 2017).
The 2015 FGM health needs assessment estimated there were likely to be approximately 115 girls in Suffolk schools from FGM practising countries with 470 women and girls at risk or having experienced FGM (Public Health Suffolk 2015).
FGM is a safeguarding issue (NSPCC 2017).
The Local Safeguarding Children’s Board (LSCB) coordinate this work at a community level.
Suffolk has a Multi-Agency Safeguarding Hub (MASH) professionals and others with concerns about FGM. You can contact the MASH about concerns and make referrals.
Protection Orders can be made where there is judged to be sufficient risk of FGM to a child (Home Office 2016).
National and local referral pathways are in place for those who are concerned about a child who has experienced or who may be at risk of FGM.
The NHS have developed the NHS Safeguarding App, which is a resource for healthcare professionals to increase their awareness and understanding of safeguarding requirements. Download it by clicking the links below.
Survivors Stories and Support
Child-line can be contacted if you or someone you know is worried about FGM.
National FGM Centre - Run by Barnardos's
NHS England - FGM strategy
Royal College of Nursing - resources for professionals work in area of FGM
Suffolk Refugee Support - Hidden Harms, FGM work
The Source - FGM information for young people
iCash - Suffolk’s integrated contraception and sexual health service
Suffolk Police - FGM specific advice
Make a Change Team – working with young people at risk of exploitation and open to social work. Contact at MAC@suffok.gcsx.gov.uk
Resources and Training
Online resources and training can be accessed through several of the national organisations listed above. A number of these are free to download.
Face to face training is available through some national and local providers and independent trainers. The National FGM Centre (based at Barnardos) has produced an Assessment Tool and good practice guidance document specifically for social workers.
The National FGM Centre has produced a legal fact sheet to highlight the different FGM legislation in England, Wales, Northern Ireland and Scotland.
This can be used by professionals and community groups working with families to help explain the law surrounding FGM.
Acute Hospitals FGM Policies
Guidance for Professionals
NHS Choices website can direct you to where you can get more information or leaflets in other languages