Petals for Professionals

Choose the correct resource

If you are a young person living in the UK and want to find out more about Female Genital Mutilation (FGM) and how it might affect you or others you may know. Please follow the link 'Petals for Young People' below

Petals for Young People | petals.coventry.ac.uk

Otherwise

Petals for Professionals is a new online resource which explains the legal responsibilities of professionals and provides information on where to get further help and advice.

Petals for Professionals | petals.coventry.ac.uk/prefessionals

Petals for Professionals

Background

In July 2015, Coventry University launched an interactive web app on FGM for young people called 'Petals'.

petals.coventry.ac.uk

The purpose of the web app was to educate young people between the ages of 11 – 17 about FGM, the health and legal consequences of the procedure, the myths associated with its continuation and in particular where to go to get further advice and help. The University worked with a group of young people from the Sidney Stringer Academy in Coventry to ensure that the web app had the most appropriate tone, language and format which would appeal to young people themselves. In addition the web app had in-built privacy features to allow young people to view the web app without fear that others could trace their usage of it.

A few months later the University was commissioned by Coventry City Council to develop a web app aimed at increasing the knowledge of FGM amongst professionals such as teachers, healthcare workers, social workers and the police. Petals for Professionals is designed to give professionals the most up-to-date information in a useable format including not only the latest legislation but also a range of videos which help to bring the content to life. In particular it stresses the important role that professionals play in preventing FGM, protecting those at risk and supporting survivors of FGM. It explains the legal responsibilities of professionals and provides information on where to go to get advice, help and more information on this abuse of girls' and women's human rights.

Coventry City Council is the first local authority in the country to take a proactive approach to tackling FGM and protecting girls and young women.

Listen to "Councillor Alison Gingell", talking about the Council’s approach to FGM. Sadly Councillor Gingell passed away in 2016 and this web app is a tribute to her and her activism in tackling FGM in the City of Coventry.

[www] Listen to Councillor Alison Gingell on Youtube | www.youtube.com/watch?v=I3CV8l1oLaE

We hope that this web app helps all professionals to take a more informed and pro-active approach to tackling FGM. Ultimately by working with each other and with affected communities we will eradicate FGM in this country within a generation, hopefully sooner.

Definition

According to the World Health Organisation (WHO), female genital mutilation (FGM) refers to all types of procedures that involve the "partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons" (WHO, 2000).

The practice is sometimes called female genital cutting (FGC), traditional cutting or female circumcision. The preferred term adopted by the WHO is female genital mutilation. This is because ‘mutilation’ reinforces the gravity of the harm of the practice and also reflects that it is a human rights violation.

In the UK FGM is common among some migrant communities from Africa, Asia and the Middle East. It is a cultural practice and carried out on both girls and women. The practice has no health benefits and has been found to cause many health problems, both physical and psychological.

Types of FGM

FGM comprises a range of different procedures. Different ethnic groups perform different kinds of FGM. The WHO has classified FGM into 4 major types.

[www] View Animation of 3 types of FGM | www.youtube.com/watch?v=mePNYlY8rZg

Please note the shaded red areas in the illustrations represent parts of the vagina which are removed as part of the FGM process.

Type 1

This is the 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). This is sometimes called a clitoridectomy.

Type 2

This is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva ). This is sometimes called 'excision'.

Type 3

This is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris. This is known as 'infibulation'

Images adapted from WHO (2008) classification of female genital mutilation

Type 4

This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping, cauterizing and burning the genital area. This is also known as 'labia stretching/pulling'

[www] View Comfort Momoh MBE, FGM consultant talking about FGM | www.youtube.com/watch?v=HN1mulqwv5g

Countries where FGM is practised

The exact number of women and girls who have undergone FGM is unknown. However, the United Nations Children's Fund (UNICEF) estimates that more than 200 million have been subjected to the practice in 30 countries (UNICEF, 2016). These 30 countries are to be found in Africa, Asia and the Middle East. However, FGM is also practiced elsewhere, including South America, North America and Europe. It is therefore a global issue.

More than 50% of girls and women who have been subjected to FGM live in just three countries: Egypt and Ethiopia (Africa) and Indonesia (Asia).

There are ten countries where 75% of girls and women (aged 15 – 49) have had FGM performed on them, with Somalia having the highest prevalence of FGM.

Top 10 countries for FGM

Country%
Somalia98
Guinea97
Djibouti93
Sierra Leone90
Mali89
Egypt (Africa/Middle East)87
Sudan87
Eritrea83
Burkina Faso76
Gambia75

Understanding the countries and specific cultural groups that practise FGM is a key step to prevention, as migrants from countries where the practice still occurs, often take the practice with them to their host country.

While information about the practicing countries may help in identifying girls that are at risk of the practice, not every person that comes from these countries practises FGM. There is a high degree of ethnic diversity in practising countries and FGM may only be common among certain ethnic groups.

[www] View Prevalence Female Genital Cutting, 2015 | www.womanstats.org/substatics/femalegenitalcutting_2015_2correctstatic.png

Prevalence of FGM in the UK

Due to the migration of people from FGM practising countries FGM has become a problem in the UK and other western countries.

The House of Commons Home Affairs Committee (2014) estimated that around 170,000 women and girls living in the UK have been affected by FGM, and a further 65,000 young girls are at risk each year. The true extent of the practice is unclear due to the ‘hidden’ nature of it.

FGM is most common in large cities and towns which have large migrant populations from practising countries. Cities such as London, Cardiff, Manchester, Sheffield, Northampton, Birmingham, Reading and Coventry have significant numbers of FGM survivors and girls at risk of FGM.

However 'Taking Local Action on FGM: An Essential Guide for Local Authorities’, (City University London and Equality Now 2015), states that ‘no Local authority area in England and Wales is likely to be free from FGM.'

[www] Taking Local Action on FGM: An Essential Guide for Local Authorities | www.trustforlondon.org.uk/research/publication/taking-local-action-on-fgm-an-essential-guide-for-local-authorities/

The FGM Enhanced Dataset

All acute health trusts, mental health trusts and GPs in England are now legally required to collect and submit data on FGM to the Department of Health. The FGM Enhanced Information Standard requires all clinicians to record in medical notes when a patient with FGM is identified and what type of FGM it is. Data has to be submitted on a quarterly basis. The Health and Social Information Centre, working with the Department of Health, manages and publishes the data.

Guidance on the recording of FGM and the FGM Enhanced Dataset standard is available at: www.hscic.gov.uk/fgm

The December 2015 report indicates that of the cases reported in England:

  • Type 1 FGM comprised 38% of cases
  • Type 2 FGM comprised 31% of cases
  • Type 3 FGM comprised 22% of cases
  • Type 4 FGM comprised 9% of cases

It also established that the highest volume of cases reported in England were reported for girls and women born in:

  • Somalia
  • Eritrea
  • Sudan
  • Nigeria

The aim of the FGM Enhanced Dataset is to collect and collate more precise figures on FGM in order to best manage the needs of those who have undergone FGM and safeguard those at risk.

FGM Enhanced Datasets can be accessed at Health and Social Information Centre website:

[www] View the Health and Social Information Centre website | bit.ly/28ZIyUI

In Wales data on FGM is collated by the FGM Lead of each Health Board.

How is FGM performed?

FGM is traditionally performed by a woman with no medical training. It is usually carried out with crude instruments such as knives, scissors, scalpels, pieces of glass or razor blades, without anaesthetic and antiseptic treatments.

There is an increasing number of cases where FGM is being performed under medical conditions such as in a clinic or elsewhere by a medically trained professional. This is called ‘medicalisation’. However, regardless of how or where FGM is carried out, it is still illegal in the UK.

The majority of women and girls living with FGM in the UK were cut in their home country before they arrived in the UK. However, there are cases where girls are being subjected to FGM here in the UK or are being sent to their parents' countries of origin to have FGM performed on them, both of which are illegal under UK legislation. Girls of school age are usually subjected to FGM in the school summer holiday, so that there is sufficient time for them to recover before they return to school. Often this takes place when a girl is moving from junior to senior school (age 11). The school summer holidays are a high risk period and often termed 'the cutting season'.

Health impacts of FGM

Research shows that FGM poses many short and long term health risks both physical and psychological. The health consequences may occur at the time of the procedure as well as during adulthood. FGM can also have an indirect effect on the psychological wellbeing of the woman/girl's sexual partner and close family members.

All of the four types of FGM are harmful; however Type III (infibulation) causes the most serious health risks due to its severe invasiveness.

Physical Problems

These include problems from actually being cut and problems which happen afterwards. Some of these problems are:

  • Extreme pain
  • Infection
  • Severe bleeding
  • Pain when urinating
  • Constant urine infections
  • Hepatitis B and hepatitis C
  • Scar tissue, cysts
  • Problems in becoming pregnant
  • Difficulties when in labour
  • Childbirth complications
  • Increase in infant and maternal mortality rates
  • Painful sex
  • Decreased levels of sexual satisfaction
  • Death from bleeding

Psychological Problems

FGM can also cause psychological or mental health problems for girls, which may stay with them for life.

These can include:

  • Feeling frightened
  • Feeling worried or anxious
  • Feeling depressed
  • Feeling traumatised or in shock
  • Feeling alone

These problems can sometimes lead to difficulties at school and college and future relationships with sexual partners. They can also cause girls to feel betrayed by their families.

[www] Listen to different women talking about their experience of FGM | www.youtube.com/watch?v=04qAO5ZzZdY

Key Legislation

FGM is illegal in the UK unless performed by a medical practitioner for 'medical reasons'.

  • 1985 - Prohibition of Female Circumcision Act (England, Wales, Northern Ireland)
  • 2003 – Female Genital Mutilation Act (England, Wales, Northern Ireland)
  • 2005 – Female Genital Mutilation Act (Scotland)
  • 2015 - Serious Crime Act

Based on these laws, it is an offence to:

  • Perform, assist or encourage FGM to be carried out either in the UK or abroad, on somebody who habitually resides in the UK as well as permanent UK residents.
  • Help a girl or woman who is an habitual resident in the UK or permanent resident of the UK to carry out FGM on herself, either in the UK or abroad.

These Acts established the maximum penalty for this criminal offence as 14 years in prison, a fine or both.

As amended by the Serious Crime Act 2015 , the Female Genital Mutilation Act 2003 now also includes:

  1. An offence of failing to protect a girl from the risk of FGM; in the case of girls under the age of 16, each individual responsible for the girl when the FGM was performed is liable under the legislation. (Maximum 7 years imprisonment)
  2. Extra-territorial jurisdiction over offences of FGM committed abroad by UK nationals and those habitually (as well as permanently) resident in the UK.
  3. Lifelong anonymity for victims of FGM.
  4. FGM Protection Orders which can be used to protect girls at risk.
  5. A mandatory reporting duty which requires regulated professions (including teachers, healthcare professionals and social workers) in England and Wales to report to the police when FGM has been performed on girls under the age of 18. This came into effect on 31st October 2015 .

In addition FGM is covered under wider child protection and domestic violence legislation

The duty to mandatory report FGM applies to Professionals in England and Wales as follows:

  • Professionals regulated by a body overseen by the Professional Standards Authority (with the exception of the Pharmaceutical Society of Northern Ireland). This includes doctors, nurses, midwives, and, in England, social workers.
  • Teachers, including qualified teachers or people employed or engaged to carry out teaching work in schools and other institutions. In Wales it includes education practitioners regulated by the Education Workforce Council.
  • Social care workers in Wales.

FGM Protection Orders(FGMPOs)

The Serious Crime Act (2015) has instituted FGM Protection Orders (FGMPOs) for girls and women.

NOTE whilst the FGMPOs use the term 'girl' throughout the documentation girls and women of all ages can be protected through an FGMPO.

The purpose of FGMPOs is to:

  • Protect a girl/woman against the commission of an FGM offence.
  • Protect a girl/woman against whom such an offence has been committed.

A FGMPO can be applied for by the girl/woman who is to be protected or a third party such as professionals, local authority, family members. A Court can also make an FGMPO without application being made to it in certain family and criminal proceedings. For example a Court might put an FGMPO on a younger sister of a victim of an FGM offence which is being heard in the court.

The court 'can make an order which prohibits, requires, restricts or includes any other such terms as it considers appropriate to stop or change the behaviour or conduct of those who would seek to subject a girl to FGM or have already arranged for, or committed FGM.', (Multi-Agency Statutory Guidance on FGM, HM Government, 2016, page 21)

Examples of the types of FGMPO that might be made include:

  • To protect a victim or potential victim at risk of FGM from being taken abroad.
  • To order the surrender of passports or any other travel documents, including those of the girl/woman to be protected.
  • To prohibit specified persons from entering into any arrangements in the UK or abroad for FGM to be performed on the person to be protected.
  • To include terms which relate to the conduct of individuals named in the FGMPO both inside and outside the UK.
  • To include terms which cover individuals who are or may become involved in other respects and who may commit or attempt to commit FGM against a girl/woman.

The breach of an FGMPO is a criminal offence with a maximum of 5 years imprisonment; or as a civil breach (contempt of court) punishable by up to two years in prison.

FGMPOs can be applied for online using the following website:

[www] Get a female genital mutilation protection order | www.gov.uk/female-genital-mutilation-protection-order

If a girl/woman is applying on her own behalf she must complete form FGM001.

If you are applying for an FGMPO for somebody else you will need to complete form FGM006.

Whilst the FGMPO is the responsibility of the police to enforce, all relevant professionals need to work closely together with the girl or woman who is to be protected to ensure the relevant support services are in place and the level of protection is adequate.

Identifying girls at risk

As part of performing their safeguarding role, professionals need to be alert to identify situations where a girl may be at risk of FGM or has undergone the practice already. This is needed both for prevention and provision of support to victims.

The Multi-agency Statutory Guidance on FGM (HM Government, 2016) lists a number of principles that professionals need to adhere to in relation to identifying and responding to those at risk, or who have undergone FGM, and their parents and guardians:

  • The safety and welfare of the child is paramount
  • All agencies should act in the interests of the rights of the child
  • FGM is illegal in the UK
  • FGM is an extremely harmful practice
  • Accessible, high quality and sensitive health, education, police, social care and voluntary sector services must underpin all interventions
  • As FGM is often an embedded social norm, engagement with families and communities plays an important role in contributing to ending FGM
  • All decisions or plans should be based on high quality assessments (in accordance with 'Working together to safeguard children' (2015) statutory guidance in England and the 'Framework for the assessment of children in need and their families in Wales.' (2001)

Risk Factors indicating a girl is in danger

A range of indicators exist that would suggest that FGM has taken place or is about to take place. These indicators may not mean much when they occur individually, but may be significant if one or more occur at the same time.

General Risk Factors

A girl may be generally at risk of FGM if:

  • Her parents (mother and/or father) are from an FGM practising country and belong to an ethnic group that practices FGM
  • Her mother, sisters or other family members have undergone FGM

Potential Risk Factors

In addition to general risk factors there may also be potential risk factors including:

  • Strong levels of influence of elders, such as grandmother, in the upbringing of the girl
  • Family believe FGM is integral to their cultural or religious identity
  • Family has limited integration into British society
  • Family not engaging with professionals (e.g. health and education)
  • Girl is withdrawn from Personal, Social, Health and Economic (PSHE) classes
  • Girl has attended a travel clinic or equivalent for vaccinations and/or anti-malarial medication
  • Sections are missing from the girl's Red Book
  • Family already known to social care in relation to other safeguarding issues
  • Parents have little knowledge of the harmful effects of FGM
  • Parents do not know the UK law concerning FGM

Professionals should complete the in depth risk assessment found on their local Safeguarding Children's Board Website or the BAFGM website. The completed assessment should then be sent to the MASH (multi agency safeguarding hub) Team for discussion and possible response. The MASH may make a referral to the Information Advice and Support Service (IASS) for strategy discussions with the police and coordinated Children's Services.

[www] Visit the BAFGM website | bafgm.org

Signs that FGM is imminent

These indicators suggest that FGM may be about to happen:

  • When a girl requests help from a teacher or another adult because she is aware or suspects that she is at immediate risk of FGM
  • Parent or family member expresses concern that FGM might be carried out on the girl
  • When a girl tells a professional she is to have a 'special procedure' or is to attend a special occasion to 'become a woman'
  • When a girl visits or talks about going on a long holiday to the home country, especially where FGM is practised
  • When a parent says that they or their relative will take the girl to the home country where FGM is practised
  • When a family member (especially grandmother) visits from a home country where FGM is practised
  • When a professional hears from the girl or her friends that she is going to be subjected to FGM. They may not refer to it as FGM but rather the local terminology

If risk of harm is imminent, emergency measures need to be implemented immediately to protect the girl. This will require reporting suspicions to the Police using 999. They will consult with the UK Border Agency and Children's Services. A protection plan will be agreed and actioned.

Signs that FGM has already taken place

These indicators suggest that FGM may have already been performed on a girl/woman.

  • Girl/woman discloses she has undergone FGM
  • Difficulty or looking uncomfortable when walking, sitting or standing
  • Finds it hard to sit still for long periods of time, which was not the case previously
  • Spends longer than normal in the bathroom and toilet due to difficulties urinating
  • Frequent urinary, menstrual or stomach problems
  • Prolonged and repeated absences from school
  • Reluctance to undergo normal medical examinations
  • Pain or discomfort between legs
  • Avoids physical exercise or requests to be excused from PE classes without a GP's letter
  • Feeling anxious, depressed and emotionally withdrawn
  • Sudden decline in performance, aspirations or motivation

Professionals subject to Mandatory Reporting requirements must report suspected cases of FGM in girls under18 years old to the police.

The Department of Health has recently issued a detailed risk assessment tool and guidance regarding FGM and safeguarding to be used to assess the risk of FGM on girls and women. This can be found in the following document:

Department of Health, 2015, Female Genital Mutilation Risk and Safeguarding: Guidance for professionals.

This is designed for health professionals and includes a risk assessment of pregnant women, non-pregnant women over the age of 18 years and girls under the age of 18.

[www] Visit Female Genital Mutilation Risk and Safeguarding Guidence for Professionals | www.gov.uk/government/uploads/system/uploads/attachment_data/file/418564/2903800_DH_FGM_Accessible_v0.1.pdf

Risk assessment tools

  • Pregnant woman (or recently given birth): page 22
  • Non-pregnant adult woman (over 18): page 23
  • Child/young adult (under 18) at risk of FGM: pages 24 – 25
  • Child/young adult (under 18) who has undergone FGM: pages 26 - 27

Legal responsibility of professionals

The legislation requires regulated health and social care professionals and teachers in England and Wales to make a report to the police where, in the course of their professional duties, they either:

  • Are informed by a girl under 18 that an act of FGM has been carried out on her
  • Observe physical signs which appear to show that an act of FGM has been carried out on a girl under 18 and they have no reason to believe that the act was necessary for the girl's physical or mental health or for purposes connected with labour or birth

Regulated Professionals - Mandatory Reporting Responsibilities

Under the Serious Crime Act (2015) regulated professionals have a legal duty to contribute to protecting girls from FGM. These responsibilities are spelt out in both the specific FGM legislation and wider child safeguarding guidelines.

The Serious Crime Act 2015 requires professionals employed in regulated professions in the UK to make an immediate report to the police if they encounter a 'known case' of FGM in the course of their work. These professionals include teachers, health care professionals and social workers. This came into force on 31st October 2015.

The Serious Crime Act (2015) states that this mandatory report:

  • Is to be made to the chief officer of police for the area in which the girl resides.
  • Must identify the girl and explain why the notification has been made.
  • Must be made before the end of ONE MONTH from the time when the person making the notification first discovers that an act of FGM has been performed on the girl.
  • May be made orally or in writing.

NOTE: the report must be made DIRECTLY to the police rather than to social care.

This mandatory reporting applies to FGM cases where:

  • The victim is under 18 years old.
  • The girl informs the professional that FGM has been carried out on her.
  • The professional observes signs which appear to show that an act of FGM has been carried out and has no reason to believe that the act was necessary for the girl's physical or mental health, or for the purposes connected with labour or birth.

The reporting obligation does not give professionals the mandate to perform any physical examination on the girl to ascertain if FGM has occurred if that is not already part of their job. For example, while healthcare professionals may undertake physical examination of girls through which FGM may be discovered, social workers and teachers may not. These professionals are only required to ‘pass on’ their ‘suspicion’ to the police for further investigation.

Professionals who fail to comply with mandatory reporting and safeguarding procedures may face disciplinary action from their professional regulator. This may include recommendations for retraining, suspension, supervision and dismissal from the profession or the withdrawal of a licence to practice.

The Multi-agency Statutory Guidance on FGM (HM Government, 2016) states very clearly:

'FGM is child abuse, and employers and the professional regulators are expected to pay due regard to the seriousness of breaches of the duty.' (page 25)

Mandatory Reporting Pathway

Under the Serious Crime Act (2015) teachers, health care professionals and social workers, are legally required to follow specific guidelines for reporting known cases of FGM in girls under the age of 18 to the police.

In the event that a professional needs to report that they suspect that a girl under 18 years has undergone FGM they must do the following:

  1. Report to a police station nearest to where the girl lives. Ideally report immediately, or by close of the next working day. A longer reporting timeframe may be considered under special circumstances, especially if reporting immediately will cause a safeguarding risk to the girl. Reports may be done orally or in writing and must be done within one month.
  2. If you believe there is risk to the life of the girl or the likelihood of serious harm, then you should ring 999 immediately.
  3. If you do not believe there is immediate risk to the girl or likelihood of serious harm, you should ring 101, the police non-emergency number as this will direct you to the police force of the local area.
  4. The call handler will take information needed to refer the case to the relevant professionals. Be prepared to provide the following information to the call handler:
    • Your personal details (e.g. name, contact details, role, place of work)
    • Details of your organisation (e.g. name of the organisation’s safeguarding lead)
    • The girl's (victim) details ( including name and address)
    • Explanation of why you think she has been the victim of FGM
  5. Make sure you are given a reference number for the report by the call handler.
  6. Inform your organisation’s safeguarding lead about the FGM disclosure/suspicion and what you have done so far.
  7. Keep a record of everything you do including the disclosure/ suspicion of FGM, safeguarding actions, police reports etc.
  8. Together with your organisation’s safeguarding lead, assess if it is appropriate to inform the girl’s parents/guardians. It is normally good practice to inform the girl's parents after the report has been made to the police. However, where reporting could lead to safeguarding risks to the girl, it is advisable not to report it to the parents/guardians.
  9. Once the report has been logged continue with your wider safeguarding and professional duties to the girl.

After the report, the police are expected to initiate a multi-agency response which will consider measures that will be needed to protect the girl and provide her with the support she needs.

The FGM Mandatory Reporting Process Map is shown below:

[www] View the Mandatory reporting duty flow chart | www.gov.uk/government/uploads/system/uploads/attachment_data/file/525405/FGM_mandatory_reporting_map_A.pdf

[www] Source: Mandatory Reporting of Female Genital Mutilation – procedural information | www.gov.uk/government/uploads/system/uploads/attachment_data/file/469448/FGM-Mandatory-Reporting-procedural-info-FINAL.pdf

Information on mandatory reporting and how to make a report can be found here:

[www] Visit Mandatory reporting of female genital mutilation: procedural information | www.gov.uk/government/publications/mandatory-reporting-of-female-genital-mutilation-procedural-information

Additional information for healthcare professionals in England can be found here:

[www] Visit FGM: mandatory reporting in healthcare | www.gov.uk/government/publications/fgm-mandatory-reporting-in-healthcare

Why people practise FGM

FGM is a complex practice motivated by a range of different factors. While the motives for the practice may vary from one ethnicity to another, they are mostly underpinned by cultural and religious myths. FGM is a social norm that is followed and enforced by communities with little or no questioning.

[www] View Factors promoting and hindering the practice of female genital mutilation/cutting (FGM/C) | www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwiyn6yi-vfMAhWIF8AKHWybBUAQFggkMAA&url=http%3A%2F%2Fwww.kunnskapssenteret.no%2Fpublikasjoner%2F_attachment%2F166681%3F_ts%3D14853c1a917%26download%3Dfalse&usg=AFQjCNF78vodTFx7fcUh_7LwwBDxpf3aMg

In a systematic review of 25 studies of the factors promoting and hindering FGM in Western countries, Berg et al (2010) concluded that there is 'an intricate web of cultural, social, religious and medical pretexts for FGM/C'.

One of the reasons most commonly used to support FGM is that it helps to control girls'/women's sexuality and enables them to maintain their virginity prior to marriage. For example, it is believed that the excision of the clitoris reduces a girl's libido and thus prevents her from being involved in sex before marriage and in extra martial sexual relations. The covering of the virginal opening through infibulation (Type III) is designed to cause pain during sex, which will discourage girls enjoying sex before marriage. At the time of marriage the bride is commonly opened up (cut open) to allow sexual intercourse by the groom.

Marriageability is an important factor in perpetuating the practice of FGM. Girls who have undergone FGM and are able to maintain their virginity are well respected in their communities. Parents believe that having their daughters cut (and thus preserving their virginity) gives them better prospects of finding a husband from a 'good' family.

Parents are also motivated by the community respect derived from subjecting their daughters to FGM. They are seen as responsible parents, with virtuous daughters who are adhering to the traditions of their home country.

FGM can also be underpinned by religious motives. It has been found to be common among Muslims, Christians and orthodox Jews. However, FGM has no religious basis and no religious script has been found to support it. Some families believe that FGM makes girls purer and that it is required by religion. For example, some Muslims believe that FGM is an approved practice of the Prophet Mohammed, so they call it 'sunna' and perform it to gain religious reward.

[www] FORWARD UK has produced a leaflet entitled FGM – Islam | www.forwarduk.org.uk/wp-content/uploads/2014/12/FGM-Islam-Leaflet.pdf

In some cultures FGM is seen as an ideal for femininity and modesty. For example in some cultures the clitoris is considered as a masculine organ that needs to be cut to make a woman feminine. In contrast, women who have not undergone FGM are regarded as unfeminine.

In many communities girls are not accorded the privileges of womanhood if they have not undergone FGM. FGM is considered as a rite of passage through which girls learn to become good wives and mothers. Women who have not undergone FGM are stigmatised and excluded from social events such as naming ceremonies, weddings and funerals and are prohibited from eating with the rest of the community.

FGM is also associated with cleansing. Some believe the clitoris produces an offensive discharge and produces bad smells. The Arabic word for FGM is 'tahur', which literally means purity and cleanliness. It is believed that if a woman has not undergone infibulation, air will enter through her vagina and cause an infection.

Most people in the UK who practise FGM think that it is a cultural tradition which must be followed at all costs. It is seen as an identity marker, which defines their religious and cultural identity. Some people fear that not practising FGM will lead to them being accused of abandoning their culture.

"Now that you know, say NO to FGM" - Professionals

[www] Watch Now that you know, say NO to FGM on YouTube | www.youtube.com/watch?v=WCOZq8vCXjY

How FGM is enforced within communities

FGM is a social norm and enforced through social mechanisms. Both girls and parents are faced with social pressures to conform. Such pressures emanate from both the migrant/diaspora community as well as relatives in the parents' country of origin.

The pressures that enforce FGM take the form of subtle rewards and punishments.

At the household level FGM is enforced by the girl's parents and extended family including grandparents, uncles and aunts. Mothers and grandmothers are particularly influential in facilitating the process for a girl to undergo FGM. However husbands and fathers have the final say in whether FGM should be performed by providing the resources needed for the FGM procedure and accompanying ceremony and gifts.

Although extended family members often live in the country of origin, they can still be influential in persuading families who live in the UK to subject their girls to FGM. The influence is transmitted through regular communication via telephone and social media as well as visits between family members.

Men often deny their role in FGM, and call it 'a woman's affair'; yet they are very influential in promoting the practice. The father finances the practice and as head of the household wields the final approval for his daughter to be subjected to FGM. Men also enforce FGM through only marrying women who have undergone FGM.

At the community level, FGM is enforced by support from some religious leaders, traditional advisors and revered older people. Peer influence can also be a strong enforcement factor, especially where the girls' peers have undergone FGM or friends of the girl's parents have subjected their daughter(s) to the practice.

Families are motivated to subject their daughters to FGM by the prospects of marrying a man from a 'good' family, as well as respect and privileges from the community. In many migrant communities girls/women who fail to undergo FGM are stigmatised and seen as prostitutes. Being ostracised by one's extended family and community can be a big incentive to conform, as this quotation demonstrates:

"Even when parents recognise that FGM/C can cause serious harm, the practice persists because they fear moral judgements and social sanctions should they decide to break with society's expectations. Parents often believe that continuing FGM/C is a lesser harm than dealing with these negative repercussions."

(UNICEF, 2010,3)

"The Silent Scream", a short film made by Integrate Bristol tells the story of Yasmin who is trying to persuade her mother not to put her younger sister through FGM.

[www] Watch The Silent Scream on YouTube | www.youtube.com/watch?v=sTNfx8Px9Zo

Survivors' Stories

More and more survivors of FGM are standing up and speaking out against FGM. Speaking out takes courage. In the video clips below, women share their experience of FGM and how it has affected their lives.

"Ifrah Ahmed" Ifrah was born in Somalia but now lives in Ireland. In this video clip she talks about FGM.

[www] Watch Ifrah Ahmed on YouTube | www.youtube.com/watch?v=T4sg2Lxz2hk

"Hoda Ali" This is a video of Hoda talking about her FGM experience at a conference in Coventry in November 2014.

[www] Watch Hoda Ali on YouTube | www.youtube.com/watch?v=9t7-4Quxhs4

Men's voices on FGM

Many boys and men in the UK do not really understand what FGM is and how it affects girls and women. Once they are made aware, many are shocked and start to speak out against FGM and are joining campaigns to end it.

"Fadel Takrouri" Fadel Takrouri, Chair, British Arab Federation talking about FGM.

[www] Watch Fadel Takrouri on YouTube | www.youtube.com/watch?v=cAGdrbzZ7cc

"Now that you know, say NO to FGM" Is a short film made by a group of young men. The aim of the film is to tell young men about FGM and what men can do to stop it happening.

[www] Watch Now that you know, say NO to FGM on YouTube | www.youtube.com/watch?v=HWbwqyHyHU8

"Charlie" A student from Sierra Leone talks about FGM.

[www] Listen to Charlie on YouTube | www.youtube.com/watch?v=UiELrtDq-ic

Initiating conversations

The delivery of appropriate prevention and support activities requires that professionals engage with FGM victims and affected communities effectively. Much of this will depend on the manner in which the professional communicates and interacts with the affected person, their family and wider community. Good communication skills are essential in conducting conversations with girls/women who have had FGM, are at risk of FGM or people who are affected by FGM.

The Department of Health (FGM: Multi-agency practice guidelines) recommends that when speaking to a girl or woman at risk of FGM or who has undergone FGM the following protocols should be followed:

  • The professional conducting the conversation should be the same gender as the person they are speaking with.
  • The professional and/or interpreter should not come from the same community as the at risk/victim of FGM.
  • The professional must be aware that if they alert the family that there has been a disclosure concerning FGM then the person making the disclosure could be put at risk.
  • Have a 'story' ready to tell anyone that may see the person coming or leaving the office/premises where the conversation has taken place.
  • If the girl/woman is accompanied by a family member, friend or interpreter the accompanying person must be made aware of the full implications of confidentiality and the legal requirement for anonymity of victims of FGM.
  • Do not assume that all people from FGM practising communities want to perform FGM.

The Home Office (H M Government 2016) state that there are three key standards in conducting a conversation concerning FGM in a sensitive and appropriate way:

  1. Making the care of the girl/woman affected by FGM the primary concern: treating them as individuals, listening and respecting their dignity.
  2. Working with others to protect and promote the health and well-being of those in their care, their families and carers, and the wider community.
  3. Being open and honest, acting with integrity and upholding the reputation of the profession.

Professionals may find FGM an awkward subject to discuss because they fear coming across as culturally insensitive. However, professionals are encouraged to be proactive in initiating conversations about FGM with individuals who are affected by, or are at risk of the practice. It is through such conversations that potential cases can be identified and prevented.

Considerations for professionals

There are a number of considerations that professionals must consider when initiating a conversation with a girl or woman affected by FGM.

Make her feel comfortable

Create an opportunity for her to talk. Use welcoming and friendly body language. Ensure she is happy talking to you and if she needs an interpreter. Give her time to talk - she will be nervous and this may be the first time she has ever spoken about FGM.

Be professional

Maintain a professional approach and explain your role, authority and responsibility. Explain why it is important to ask the questions you are asking.

Don't be judgemental

Do not assume anything based on the girl's/woman's appearance, cultural and religious background. Keep an open mind, listen carefully and record all the information you need to make a good assessment of the case. Remember if she has undergone FGM she is not a criminal, but a victim.

Show respect and empathy

You must point out that FGM is illegal in the UK and explore the health effects of the practice, but do not blame the girl/ woman.

Use simple language

Avoid technical or medical terminology or jargon. Use straight forward questions. For example, in probing whether they have undergone FGM, you may ask them direct questions such as:

  • Have you been closed?
  • Have you been circumcised?
  • Have you been cut down there?
  • Tell me about your experience
  • There are many countries around the world where female circumcision is practised, has that happened to you?

You may also use leading questions such as:

  • Do you experience any pain or difficulties during intercourse?
  • Do you have any problems passing urine?
  • How long does it take you to pass urine?
  • Do you have any stomach pain or menstrual difficulties?

Maintain confidentiality

Assure her that confidentiality will be maintained. Explain the limits of confidentiality, including the fact that information disclosure may become necessary in order to provide her support services and referrals to Well Women Clinics.

Use professional interpreters

In some cases she may be concerned that using an interpreter will compromise her privacy and confidentiality. It is therefore recommended that an interpreter does not come from the same community. It is recommended that professional interpreters are used. Use telephone interpreters if possible. Interpretation should be verbatim and the girl's/woman's name should be anonymised.

Explain that FGM is illegal and causes health problems

Discuss with her the legal implications of FGM as well as the health consequences. If she is pregnant or has daughters then the legal situation must be clearly spelt out to her, with appropriate reading material for her to take away and read/share with her family.

Offer support

Assess to see what support she may need and signpost her accordingly.

Use culturally appropriate language

Avoid using judgemental terms such as female genital mutilation as this can create a sense of prejudice and stigmatisation. Instead use neutral terms such as female circumcision, female cutting. If possible use the local terminology such as 'sunna' that is used to describe FGM in her community. This will help build trust and respect with her.

Local terminologies for describing FGM

The table below provides examples of some terms used for describing FGM among FGM affected communities in the UK.

CountryTerm used for FGMLanguage
CHAD – The NgamaBagne
Gadja
-
GambiaNiaka
Kuyungo
Musolula Karoola
Mandinka
Mandinka
Mandinka
Guinea-BissauFanadu di MindjerKriolu
EgyptThara
Khitan
Khifad
Arabic
Arabic
Arabic
EtheopiaMegrez
Megrez
Amharic
Harrari
EritreaMekhnishabTigregna
IranXatnaFarsi
KenyaKutairi
Kutairi was ichana
Swahili
Swahili
NigeriaIbi/Ugwu
Didabe fun omobirin/ ila kiko fun omobirin
Igbo
Yoruba
Sierra LeoneSunna
Bondo
Bondo/sonde
Bondo
Bondo
Soussou
Temenee
Mendee
Mandinka
Limba
SomaliaGudiniin
Halalays
Qodiin
Somali
Somali
Somali
SudanKhifad
Tahoor
Arabic
Arabic
TurkeyKadin SunnetiTurkish

Source: Multi-agency Statutory Guidance on FGM (HM Government, 2016, page 71)

It is worth noting that FGM does not only affect women and girls who have undergone the practice but also their siblings, parents, grandparents and sexual partners. Hence, in some cases the professional will have to involve such individuals in conversations about FGM particularly if they believe a girl is at risk of FGM.

Professionals must always remember that:

  • 'FGM is illegal. It is child abuse and a form of violence against women and girls and therefore should be treated as such' (Multi-agency statutory guidance on FGM, 2016, page 27)
  • Safeguarding is everyone's responsibility and each professional and organisation must play their part.
  • A victim-centred approach should be taken, based on a clear understanding of the needs and views of girls and women affected by FGM.

Teachers

FGM can have a serious detrimental impact on girls' educational development. It can lead to poor performance and withdrawal due to the physical and psychological consequences of the practice. As FGM is likely to be performed on young girls who are still in school, teachers have a special responsibility and opportunity to prevent it.

Under the Serious Crime Act (2015) teachers have a responsibility to report FGM cases on children under the age of 18 that they find during the course of their work. They are also bound by wider child safeguarding laws and professional standards to protect girls from FGM. The DoE document on ‘Keeping Children Safe in Education' (2015) provides guidance for teachers, schools and colleges for safeguarding children.

General measures for tackling FGM

The following measures can be adopted by schools, colleges and their teaching staff to minimise the risk of FGM.

  • Introduce FGM into the school curriculum. FGM should be included in the school's PHSE lessons, but parents can withdraw their children from these classes, so teachers should also think about including FGM in other subject based lessons.
  • Ensure the availability of information material on FGM, including DVDs, leaflets and posters. These materials can be obtained from the local NHS.
  • Ensure that the school's safeguarding lead has a good understanding concerning FGM.
  • Ensure that staff members are trained about FGM, including how to initiate a conversation on FGM with girls and their parents.
  • Make sure staff know their Mandatory Reporting duties and safeguarding responsibilities with respect to FGM.
  • Display relevant contact information where girls can access FGM related support including NSPCC's FGM Helpline and ChildLine services.
  • Encourage girls to seek support on FGM.

What to do when a girl is at risk of FGM

Girls are most at risk of FGM during the long summer holidays, when they may be sent abroad for the procedure or will have it done here in the UK. Hence, teachers should be particularly vigilant in the days leading up to the summer holiday so that they can identify girls who may be at risk.

In the event that a girl is found or suspected to be at significant risk of FGM, as a teacher you should do the following:

  1. Have a conversation with the girl to verify the suspicion and establish the facts of the case (see 'Conversations').
    • Remember it is not within the remits of your responsibilities to investigate. Establish the facts of the case and pass it on to the police.
    • Note that she may feel shy or intimidated to talk about FGM. Hence, be sensitive, empathetic and respect her wishes. But also put her welfare at the heart of your decisions.
  2. Take anything the girl says seriously. Do not dismiss it off hand.
  3. Share your concerns with the school's safeguarding lead.
  4. Activate local safeguarding procedures, using existing national and local protocols including calling the police and social care services.
    • Note that it may not be safe to approach the girl's parents/guardians at the early stages of your suspicion. You may leave that for the police and social care services, who will approach the parents during or after their investigation.

What to do when a girl stops attending school for a prolonged period of time

When a girl from an FGM practising community stops attending school it may be an indication that FGM is imminent or has occurred. Teachers can take the following steps to safeguard the girl.

  1. Find out from the girl's friends why the she has stopped attending school. Do not disclose your suspicion to them.
  2. Contact the girl's parents/guardians to find out why she has stopped attending school. In some cases the parents will say that they have sent her abroad to study.
  3. Report the case to social care services who will carry out an investigation.

What to do if a girl has undergone FGM

Teachers should do the following if they find that a girl has undergone FGM.

  1. Talk to her to establish the facts of the case.
  2. If it is true that she has actually undergone FGM report the case to the police using the Mandatory Reporting procedures set out in the 'Referral' section.
  3. Inform her about the health consequences of FGM.
  4. Refer her for the appropriate medical and counselling support.

Remember that she might not want to be referred. However it is important to explain to her the need for such support.

[www] Watch Anita's Dilemma - FGM Lesson Starter Integrate Bristol and Zed Productions on Vimeo | vimeo.com/63205058

Social Workers

FGM is child abuse and gender-based violence; therefore social workers are more likely than any other professional to encounter FGM on a regular basis. All local authorities in the UK have multi-agency policies and procedures for handling child safeguarding issues. Social workers should use this as a general guide for dealing with FGM cases involving children.

In addition, the Home Office documents on ‘Working Together to Safeguard Children (2013) and Safeguarding Children: Working Together Under the Children's Act 2004' are useful guides that social workers in England and Wales should refer to concerning FGM.

Safeguarding scenarios

As social workers you are likely to receive referrals on FGM cases from other professionals such as teachers, the police and healthcare professionals. You are likely to also come across new cases during your normal work duties. These will be cases where a girl or a woman is at risk or has already undergone FGM.

Whatever the case may be it is important to respond appropriately in order to safeguard the welfare of the girl/woman.

What to do if a girl is at risk of FGM

  • If a referral was made, ensure you record all the necessary details of the case and acknowledge receipt to the referrer.
  • Report case to your line manager.
  • Together with your manager assess the level of risk and decide whether urgent attention is needed – i.e. if she is at immediate risk of being subjected to FGM.
  • If she is in immediate danger take immediate steps to protect her, including informing the police and seeking an Emergency FGM Protection Order.
  • Convene an inter-agency meeting involving the police, education and healthcare professionals to develop a comprehensive strategy to deal with the case.

[www] FGM Protection Order | s3-eu-west-1.amazonaws.com/hmctsformfinder/fgm001-eng.pdf

The strategy should among other things consider:

  • Speaking with the girl's parents to assess the facts of the risk.
  • Working with the girl's parents to prevent FGM from occurring. Consider leveraging community leaders if possible.
  • Seeking a written agreement from the parents committing to not perform FGM on the girl.
  • Educating the girl and her parents about the legal and medical consequences of FGM.
  • Ensuring adequate measures are put in place to monitor and enforce the agreement.
  • Using a FGM Protection Order
  • Devising a strategy to protect other girls living in the household.

What to do when a girl has already undergone FGM

  1. If you suspect that a girl under 18 has been subjected to FGM a Mandatory Report must be made to the police.
  2. Ensure you record all the necessary details of the case and send to the police.
  3. Report the case to your line manager and decide on the next course of action within the next working day.
  4. Consider if there are any immediate safeguarding actions required, including other girls in the family who may be at risk.
  5. Convene an inter-agency meeting involving the police, education and healthcare professionals to develop a comprehensive strategy to deal with the case.

The strategy should consider among other things:

  • How and where the procedure was performed.
  • What support is needed for the victim(s).
  • If there is evidence of a criminal act. If so seek legal advice and liaise with the police to conduct a criminal investigation.
  • Other possible abuses that the girl/woman is facing in the household.

Healthcare Professionals

Healthcare professionals have an important responsibility in supporting FGM victims. Due to the nature of their work, they are able to identify FGM cases, especially through routine check-ups of girls and women, and during delivery. A vaccination request for a girl to visit an FGM practising country should raise suspicion that FGM might be about to occur.

Healthcare workers have four general responsibilities when they encounter FGM in the course of their work:

  1. Assess the patient (FGM victim) and provide them with the clinical support they need. In doing so it is important to:
    • Approach it in a sensitive and professional manner (see 'Conversations'). It is important not to exhibit signs of shock, confusion, horror or revulsion at the procedure.
    • Note that women who have undergone FGM Type III (infibulation) may need de-infibulation to be able to give birth naturally.
    • Inform the victim about her options, including all the services available.
    • If possible, refer them for specialist support such as counselling.
    • Note that in some cases people who are close to the victim such as husband may also suffer psychological consequences as a result of their partner’s FGM. If so, refer them for the appropriate services too.
  2. Update victim's health records with the identified FGM case. Ensure that the correct FGM type is recorded.
    • Also, fill out the FGM Enhanced Dataset form that will enable the NHS trust to report the FGM case to the Department of Health.
    • Note that this reporting is separate from Mandatory Reporting for FGM cases involving children under the age of 18.

    [www] Watch Women talking about their personal experiences of female genital mutilation (FGM) | www.nhs.uk/video/pages/speaking-with-patients-about-fgm.aspx

  3. Report the case to the relevant authority ( e.g. police and/or social services)
    • Reporting is particularly important because other girls in the victim’s household might be at risk.
  4. Healthcare professionals may be invited to be part of a multi-agency group to devise a strategy for supporting the victim.

Note

FGM cases involving adults are considered as domestic violence. Therefore, healthcare professionals are not required to report this to the police and/or social services due to patient confidentiality. However, if you find the need to report the case make sure you obtain the explicit consent of the victim before you do so.

" Dr Abdullah Shehu ", Consultant Neurologist at University Hospital Coventry and Warwickshire talks about FGM

[www] Watch Dr Abdullah Shehu on Youtube | www.youtube.com/watch?v=wpMRV7E3sqM

Prevention measures

Healthcare professionals should complete the FGM Risk Indication System (FGM RIS). This is a national IT system for health that allows clinicians across England to note on a girl's record within the NHS Summary Care Record application that they are potentially at risk of FGM. This allows the potential risk of FGM to be shared confidentially with health professionals across all care settings until a girl is 18 years old.

If a girl is identified as being at risk of FGM, the FGM risk indicator should be added to the system following completion of an FGM risk assessment (see Department of Health, 2015, FGM risk and safeguarding guidance for professionals.)

The FGM RIS should be used in conjunction with local safeguarding frameworks and processes.

Only authorised health professionals with the relevant security permissions on their NHS Smartcard are able to access the FGM RIS. The main groups of health professionals most likely to use the system are GPs, practice nurses, midwives, school nurses, safeguarding specialists and health visitors. It can also be viewed by clinicians working in NHS travel centres, acute trusts, mental health trusts, minor injury units and A & E.

Healthcare professionals can also contribute to the prevention of FGM by doing the following:

  • Raising awareness among work colleagues about FGM
  • Displaying information materials about FGM on notice boards for both patients and staff
  • Attending training on FGM
  • Identifying and training a safeguarding lead, including training on FGM

[www] Watch FGM Victims & Health Professionals share stories! on Youtube | www.youtube.com/watch?v=rMDsZKVOOxU

The Police

FGM is a criminal offence and therefore police officers have a special responsibility to prevent, investigate and prosecute cases involving FGM. In dealing with FGM police officers are recommended to follow national and local police guidance for safeguarding and child abuse investigations.

FGM is a cultural practice and therefore needs to be approached with great sensitivity in order to engage effectively with the victim, their family and practising community.

Most cases of FGM that the police deal with will be the result of a Mandatory Report from other professionals or the general public for an action to be taken. This will mostly involve a girl/woman who is at risk or has recently undergone FGM.

"Detective Inspector Nathan Percival" of Greater Manchester Police speaks on International Day of Zero Tolerance for Female Genital Mutilation.

[www] Watch FGM Awareness - Nathan Percival on Youtube | www.youtube.com/watch?v=GlhNyHBAKNQ

Police officers should refer to the College of Policing's Authorised professional practice on FGM which includes guidance on prevention, protection and evidence collecting in cases of FGM.

What to do when a FGM case is referred to you

  1. Ensure that all relevant information is obtained from the referrer and recorded.
  2. Acknowledge receipt of the case to the referrer and issue a case reference number.
  3. Report the case to the duty inspector and together log it with the local child safeguarding team. This team will in turn report the case to the local authority's children's social care service.
  4. If the case was reported during out-of-office hours ensure that effective protection measures are put in place to ensure the safety of the victim.
    • If the girl is in immediate risk of harm consider using police protection powers.
  5. Together with the duty inspector ensure that an investigation is started on the case.
  6. Complete all necessary reports/forms, including:
    • Crime report
    • Intelligence log
    • Risk assessment and management plans
    • MERLIN entry
  7. Inform your supervisor as well as the on-call superintendent about the case.
  8. Convene a multi-agency meeting to discuss a strategy for dealing with the case.

Strategy for a girl who is at risk of FGM

The strategy should among other things consider the following:

  • Prioritise engaging with the girl's family to ensure that an amicable solution can be reached. If possible consider leveraging the support of community leaders and NGOs to gain the cooperation of parents/guardians.
  • Obtain a written agreement from the parents/guardians that they will not perform FGM on the girl.
  • Educate the girl and her family about the health and legal implications of FGM.
  • Use a FGM Protection Order to ensure the safety and welfare of the girl if necessary.
  • Provide protection for other girls in the family who may be at risk.
  • Regularly monitor the progress of the strategy and review accordingly.

Strategy for a girl/woman who has already undergone FGM

This should consider the following:

  • Treat the case as a critical incident.
  • Institute an investigation. Obtain the necessary evidence including identifying the excisor and the networks of perpetrators.
  • Discuss possibility of a criminal prosecution.
  • When obtaining evidence from the girl/woman ensure that their consent is obtained to record the interview and use it in the criminal court.
  • Commission a comprehensive medical examination to obtain corroborative evidence for the case and also to provide the victim with the support they need.
  • Education of girl/woman about health implications of FGM.
  • Liaise with health service professionals to provide appropriate health support services.

Who should I contact if I am concerned about FGM and the safeguarding of a child?

If you think the girl is at imminent risk of FGM then you must speak to your local police child protection officer or ring 999. If you do not think the girl is at imminent risk you must report your suspicions to your safeguarding lead.

Where do I get information concerning local policy on safeguarding girls from FGM?

You should access your local LSCB website.

If I have concerns that a girl might be at risk of FGM should I discuss those concerns with her parents?

No, as this could put her in imminent danger of FGM or of removal from the UK for the purpose of FGM. Get advice from your safeguarding lead for guidance. If you think the girl is at imminent risk of FGM then you must contact your local police child protection officer or ring 999.

Resources for all Professionals

[www] Petals.coventry.ac.uk – a web app on FGM designed specifically for young people between the ages of 11 – 17 | petals.coventry.ac.uk

[www] Multi-agency statutory guidance on female genital mutilation (2016) | www.gov.uk/government/publications/multi-agency-statutory-guidance-on-female-genital-mutilation

[www] Home Office (2016) Fact sheet on mandatory reporting of female genital mutilation | www.gov.uk/government/publications/fact-sheet-on-mandatory-reporting-of-female-genital-mutilation

[www] HM Government, (2015) Working Together to Safeguard Children | www.gov.uk/government/publications/working-together-to-safeguard-children--2

[www] HM Government (2014) Multi-Agency Practice Guidelines: Female Genital Mutilation | webarchive.nationalarchives.gov.uk/+/http://www.isb.nhs.uk/documents/isb-1610/amd-01-2014/1610012014mapguid.pdf

[www] HM Courts Service Application forms for FGM Protection Orders and information in different languages | www.gov.uk/female-genital-mutilation-protection-order

[www] Mandatory Reporting of Female Genital Mutilation: Procedural Information | www.gov.uk/government/uploads/system/uploads/attachment_data/file/469448/FGM-Mandatory-Reporting-procedural-info-FINAL.pdf

[www] Working Together to Safeguard Children (2013) | www.gov.uk/government/uploads/system/uploads/attachment_data/file/417669/Archived-Working_together_to_safeguard_children.pdf

[www] Department of Health (2015) Female Genital mutilation: Risk and safeguarding – guidance for professionals. | www.gov.uk/government/uploads/system/uploads/attachment_data/file/525390/FGM_safeguarding_report_A.pdf

[www] Home Office (2015) Mandatory Reporting of Female Genital Mutilation:Procedural Information | www.gov.uk/government/publications/mandatory-reporting-of-female-genital-mutilation-procedural-information

[www] HM Government (2015) what to do if you’re worried a child is being abused | www.gov.uk/government/publications/what-to-do-if-youre-worried-a-child-is-being-abused--2

Resources for Teachers

[www] Keeping Children Safe in Education 2015 | www.gov.uk/government/publications/keeping-children-safe-in-education--2

[www] Personal, Social, Health & Economic PSHE) education has a range of resources teachers can access | www.pshe-association.org.uk/

[www] Integrate Bristol is a charity that works towards equality and integration. | integratebristol.org.uk/resources/

Integrate Bristol is a charity that works towards equality and integration. They have produced educational resources around FGM to use in schools.

Resources for Social Workers

[www] Working Together Under the Children’s Act 2004 (2004) - Wales | www.wales.nhs.uk/sitesplus/documents/863/Safeguarding%20Children%20Working%20Together%20under%20the%20Children%20Act%202004%20%282006%29.pdf

[www] FGM Screening Toolkit | cdn.basw.co.uk/upload/basw_50727-6.pdf

Resources for Health Professionals

[www] Department of Health (2015) Mandatory reporting resources for healthcare professionals. | www.gov.uk/government/publications/fgm-mandatory-reporting-in-healthcare

[www] Royal College of Nursing (2015) Female Genital Mutilation | www.rcn.org.uk/clinical-topics/female-genital-mutilation

[www] Royal College of Obstetricians & Gynaecologists (2015) FGM and its management (Green-top Guidance No 53) | www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg53

[www] Department of Health, Statement Opposing FGM | www.orderline.dh.gov.uk

Also known as 'Health Passport' which sets out the law on FGM and sources of help and support. Available in 11 languages.

Resources for The Police

[www] College of Policing (2015) Authorised professional practice: female genital mutilation. | www.app.college.police.uk/app-content/major-investigation-and-public-protection/female-genital-mutilation/

Training Resources for Professionals

[www] Home Office, e-learning module on FGM: How to recognise and prevent it | www.fgmelearning.co.uk/

[www] Home Office (2015) FGM resource pack | www.gov.uk/government/publications/female-genital-mutilation-resource-pack

Case studies, links to organisations and resources to support local work to tackle FGM

[www] Health Education England, free e-learning resource for health and social care professionals: | www.e-lfh.org.uk/programmes/female-genital-mutilation

[www] Welsh Government, Live fear free: training on domestic abuse, sexual violence and violence against women. | livefearfree.gov.wales/guidance-for-professionals/national-training-framework/?lang=en

Legislation

[www] Female Genital Mutilation Act 2003 | www.legislation.gov.uk/ukpga/2003/31/pdfs/ukpga_20030031_en.pdf

[www] Female Genital Mutilation (Scotland) Act 2005 | www.legislation.gov.uk/asp/2005/8/contents

[www] Serious Crime Act 2015 | www.legislation.gov.uk/ukpga/2015/9/contents/enacted

Prevalence Data

[www] HSCIC, NHS England FGM data | www.hscic.gov.uk/article/2021/Website-Search?q=fgm&go=Go&area=both

[www] Female Genital Mutilation Prevalence Dataset Standard Specification | webarchive.nationalarchives.gov.uk/+/http://www.isb.nhs.uk/documents/isb-1610/amd-01-2014/1610012014spec.pdf

[www] Female Genital Mutilation Prevalence Dataset Implementation Guidance | webarchive.nationalarchives.gov.uk/+/http://www.isb.nhs.uk/documents/isb-1610/amd-01-2014/1610012014impguid.pdf

[www] Macfarlane, A & E. Dorkenoo (2015) Prevalence of female genital mutilation in England and Wales: National and local estimates. London, City University London and Equality Now | openaccess.city.ac.uk/12382/

Other Useful Resources

[www] The National FGM Centre | nationalfgmcentre.org.uk

The National FGM Centre is a partnership between Barnardo's and the Local Government Association. It aims to end new cases of FGM for women and girls living in England within the next 15 years, (LGA)

[www] Women's Support Project – training resources developed in Scotland | www.womenssupportproject.co.uk/vawtraining/content/femalegenitalmutilation/277,234/

[www] Birmingham Against FGM (bafgm) | bafgm.org/about-us/

Birmingham Against Female Genital Mutilation seeks to lead and co-ordinate multi-agency activity to prevent the practice of FGM; to protect girls from FGM and to address the physical, psychological and emotional health and support needs of women and girls who have undergone FGM. There are lots of resources on their website.