Female genital mutilation (FGM)

Introduction

FGM is known by a variety of names, including ‘female genital cutting’, ‘circumcision’ or ‘initiation’ and describes mutilation of the labia majora, labia minor or clitoris.  Female genital mutilation can have serious and harmful long-term psychological and physical effects and women or girls may present with immediate/short-term consequences of FGM, including severe pain, shock, haemorrhage, wound infections, urinary retention, injury to adjacent tissues, genital swelling, and/or death.

FGM is illegal in the UK. It is child abuse and a form of violence against adult women and girls.  Anyone who commits FGM faces up to 14 years in prison, a fine, or both. Anyone found guilty of failing to protect a girl from risk of FGM faces up to 7 years in prison, a fine, or both.

The practice is NOT required by any religion.  However, FGM is a deeply embedded social norm in particular community groups, practised by families for a variety of complex reasons. It is often thought to be essential for a girl to become a proper woman, and to be marriageable.  It is practised in the UK or abroad in both medicalised and non-medicalised settings.

Getting help and support

The practice is illegal in the UK and it is compulsory for family doctors, hospitals and mental health trusts to report any new cases in their patients.

Midwives and doctors working in maternity and obstetric units seem best placed to identify FGM.

  • Someone in immediate danger? Contact the police. Dial 999.
  • Concerned someone may be at risk? Contact the NSPCC helpline on 0800 028 3550 or fgmhelp@nspcc.org.uk or the Bracknell Forest Multi-Agency Safeguarding Hub (MASH
  • Under pressure to have FGM performed? Ask your GP, health visitor or other healthcare professional for help, or contact the NSPCC helpline.
  • Are you a health, social care professional or teacher working with a young person under 18 who has, or you suspect has, undergone FGM?  You are legally required to report any activity to the police.  Mandatory Reporting of FGM – procedural information is available on the GOV.UK website.  For an adult who discloses FGM you can directly refer to Dr Fatima Husain at Wexham Park Hospital (01753 633000) to discuss options and be signposted to support.
  • Have you had FGM?  You can get help from a specialist NHS gynaecologist or FGM service - ask your GP, midwife or any other healthcare professional about services in your area.

Key inequalities and risk factors

According to the NSPCC, most girls are aged 5 to 8, but FGM can happen at any age before getting married or having a baby. Some girls are babies when FGM is carried out.  Certain individuals and communities are also more vulnerable. NHS Digital data for 2016/17 indicates 95% of the women and girls had undergone FGM before they were 18 years old.

Women and girls concerned are very diverse and there are several signs (many of which will require additional contextual information) which might suggest a person is at risk or harm or has been subject to FGM.    The following is not an exhaustive list from Annex B of the multi-agency statutory guidance (April 2016):

  • a female child is born to a woman who has undergone FGM
  • a female child has an older sibling or cousin who has undergone FGM
  • a female child’s father comes from a community known to practise FGM
  • family origin is from one of the 30 known countries where FGM is practiced (see the map below)
  • women or girls in a family who have heard of or who are members of the Sande society (Liberia), this is a secret organisation in which FGM is a rite of passage and performed during initiation into the society
  • a woman/family that believes FGM is integral to cultural or religious identity – although it should not be assumed that the daughters of affected women will also be victims as families may give up FGM on migration and change attitudes
  • migrant women and girls from risk communities or families living in major towns and cities or with transport links to urban centres and also those in rural areas are more likely to be socially isolated and unable to disclose or access support or help
  • a girl/family has limited level of integration within UK community
  • parents have limited access to information about FGM and do not know about the harmful effects of FGM or UK law
  • where FGM is a societal or cultural norm, elders, parents or individuals may not be that the practice is illegal or what the consequences are
  • prolonger periods out of the country, e.g. a girl talks about a long holiday to her country of origin or another country where the practice is prevalent or parents state that they or a relative will take the girl out of the country for a prolonged period
  • a family is not engaging with professionals (health, education or other)
  • a family is already known to social care in relation to other safeguarding issues
  • a girl from a practising community is withdrawn from Personal, Social, Health and Economic (PSHE) education or its equivalent
  • a girl is unexpectedly absent from school
  • sections are missing from a girl’s personal child health record (‘Red book’)
  • a girl has attended a travel clinic or equivalent for vaccinations / anti-malarials

Signs that a girl or women may have been subject to FGM include:

  • difficulty walking, sitting or standing or looking uncomfortable whilst seated and for long periods
  • extended or prolonged bathroom breaks
  • presentation (or increased presentation) in medical settings with urinary, menstrual or stomach problems or presenting with non-specific or ambiguous concerns or issues and difficulty talking about the genital area
  • refusal of clinical or medical examination
  • prolonged or repeated absence from school or avoidance of PE
  • behavioural or emotional change or distress

If any risk factors are identified, professionals will need to consider what action to take. If unsure whether the level of risk requires referral, professionals should discuss with their named/designated safeguarding lead. Caution should also be exercised in the use of interpreters who may be selective in what information they share.

Mandatory reporting requires professionals to report to the police, usually by close of the next working day, where FGM is disclosed or found or where physical signs are observed which appear to show that an act of FGM has been carried out on a girl under 18 which was not necessary for the girl’s physical or mental health or for purposes connected with labour or birth.

Facts, figures and trends

Identifying risk

It can be difficult to identify real or immediate risk of harm beyond specific disclosure, e.g. a girl requests help from a teacher or another adult because she is aware or suspects that she is at immediate risk of FGM; a parent or family member expresses concern that FGM may be carried out on the girl, or a girl talks about FGM in conversation, for example, a girl may tell other children about it.

Countries in which FGM is known to be practiced are:

Source: UNICEF global databases, 2016, based on DHS, MICS and other nationally representative surveys, 2004-2015 (accessed 19 April 2016).

Different countries have different terms for the practice and these are listed in Annex G of the multi-agency statutory guidance (April 2016).

Consequences of FGM

The long-term consequences of FGM can include genital scarring, genital cysts and keloid scar formation, recurrent urinary tract infections and difficulties in passing urine, possible increased risk of blood infections such as hepatitis B and HIV, pain during sex, lack of pleasurable sensation and impaired sexual function, psychological concerns such as anxiety, flashbacks and post traumatic stress disorder, difficulties with menstruation (periods), complications in pregnancy or childbirth (including prolonged labour, bleeding or tears during childbirth, increased risk of caesarean section); and increased risk of stillbirth and death of child during or just after birth.

Estimated prevalence

The prevalence of FGM in England and Wales is difficult to estimate because of the hidden nature of the crime however, global and local statistics on FGM are beginning to emerge:

  • approximately 60,000 girls aged 0-14 were born in England and Wales to mothers who had undergone FGM
  • approximately 103,000 women aged 15-49 and approximately 24,000 women aged 50 and over who have migrated to England and Wales are living with the consequences of FGM
  • approximately 10,000 girls aged under 15 who have migrated to England and Wales are likely to have undergone FGM

Local authority area projections (accessed 18 April 2016) by the City University London are based on numbers of women living in each area, who were born in countries where FGM is practised, and the prevalence of FGM in those countries. Estimated figures are as follows:

 

Estimated numbers of females with FGM by age group 2015

Estimated number per 1,000 population by age group 2015

 

0-14

15-49

50+

0-14

15-49

50+

Bracknell Forest

<5

64

17

0.4

2.2

1.0

South East

599

6,724

1,323

0.8

2.0

0.8

England and Wales

9,517

101,552

23,576

2.0

7.7

2.3

The Female Genital Mutilation (FGM) Enhanced Dataset (SCCI 2026) records data collected by healthcare providers in England, including acute hospital providers, mental health providers and GP practices.  From April 2015, data will be produced on a quarterly basis and as more information is submitted the figures will become more sophisticated.

The four FGM types defined by the World Health Organisation are:

  • Type 1: Partial or total removal of the clitoris and/or the prepuce (clitoridectomy).
  • Type 2: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).
  • Type 3: Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).
  • Type 4: All other harmful procedures to the female genitalia for non-medical purposes, including pricking, piercing, incising, scraping and cauterization

Types are ranked in terms of prevalence with Type 1 and 2 being the most common, with the London care providers recording the highest levels and the South East reporting the lowest number.  The pattern of ‘unknown’ classifications is currently high (more than 55% of cases) in the initial returns but this is because even for experienced healthcare workers who frequently see women and girls with FGM it can still often be difficult to determine the type of FGM that had been undertaken.

Prevention, care and support

Local Children’s Safeguarding Board – a partnership of representatives from a broad range of services that work with children and young people, or with their parents/carers (in statutory, voluntary, community and independent settings) to oversee the safety and well-being of children and young people in Bracknell Forest. Specific pages exist for FGM on their website.

FGM e-learning (Home Office) – an online course designed to help people coming into contact with young people and their families to promote good safeguarding practice, whilst being culturally aware of the types of abuse that stem from culture related traditions, the specific cultural and religious needs of others in order to support the best possible outcomes for all children.

Want to know more?

Commissioning services to support women and girls with female genital mutilation (Department of Health, 2015) - sets out what some elements of a successful and safe service to support women and girls with female genital mutilation (FGM) might look like. It highlights the need for partnership working across multiple agencies and sectors to identify, prevent and protect girls at risk; provide support to survivors;  pursuing prosecutions when necessary, and; work in partnership across multiple agencies to achieve this.

  • Appropriate gathering of ethnicity data on FGM
  • Monitoring and recording individuals affected by FGM presenting for health and social care services
  • Developing appropriate and sensitive communication on the issue, remember FGM is a crime and women and girls who are affected are victims of crime
  • Ensuring children or adults safeguarding teams are alerted of any concerns about risks to children or vulnerable adults
  • Support may have to be organised differently in areas where only small numbers of women are affected, compared to areas with substantial populations of affected women
  • Support is needed for these women during pregnancy and childbirth and may also be needed for older women, because of long term complications of FGM

Female genital mutilation: resource pack (Home Office, 2016) – key information, issues and case studies including advice on what local authorities 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.

Plan UK - an organisation working for children and their communities to help realise children’s rights. We work across a range of sectors, including education, health, child protection and child participation.

NSPCC – information, advice and helpline for people affected by FGM, including professionals working with women and children.

Violence against women and girls: second report of session 2013-14 (House of Commons International Development Committee, 2013) - A wider exploration of interlinked cultural issues and violence against women and girls.

 

This page was created on 18 April 2016.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Female Genital Mutilation. Available at: http://jsna.bracknell-forest.gov.uk/developing-well/children-and-young-p... (Accessed: dd Mmmm yyyy)

 

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