Reconstruct Online Procedures - Female Genital Mutilation | South West Safeguarding and Child Protection Procedures

Purpose
Legislation
Definition
Background
Justification for FGM
Signs & Indicators
Policy
Practical Guidelines
Case Guidance
Children Who Have Undergone FGM
If a Woman Has Already Undergone FGM
Prevention and Training
References
Further Reading & Resources
Services
National & International Groups
Female Genital Mutilation Appendix 1
Female Genital Mutilation Appendix 2
Female Genital Mutilation Flowchart

Purpose

Female Genital Mutilation (FGM) is illegal in the UK.

FGM is a collective term for all procedures which include the partial or total mutilation of the external female genital organs for cultural or other non-therapeutic reasons.

Legislation has been in place for many years. It is known that children are subject to this procedure both in the UK and overseas.

FGM is not an acceptable practice and is a form of child abuse under UK law.

Working Together to Safeguard Children (2006) recommends that the Local Safeguarding Children Board in areas where FGM is practiced should have detailed guidance for staff when they have concerns related to FGM. The guidance should also be combined with a preventative strategy involving community education. The purpose of these procedures is to fulfil our commitment under Working Together to Safeguard Children (2006) recommendations.

Legislation

FGM has been illegal since the 1985 Female Circumcision Prohibition Act.

The new FGM Act (2003) updates and extends the original Act.

It is now:

‘An offence to take UK nationals and those with permanent UK residency overseas for the purpose of circumcision, to aid and abet, counsel or procure the carrying out of FGM. It is illegal for anyone to circumcise women or children for cultural or non-medical reasons.’

(Female Genital Mutilation Act 2003)

The FGM Act 2003 carries a maximum penalty of 14 years in prison for committing or aiding in this offence.

Definition

FGM covers a range of mutilation from the partial to total removal of the external female genital organs.

The World Health Organisation has classified FGM as four different procedures:

FGM Type 1 – Sunna – removal of the hood of the clitoris.
FGM Type 2 – Excision – removal of the clitoris with partial or total excision of the labia minora.
FGM Type 3 – Infibulation – removal of the clitoris, labia minora with narrowing by stitching of the vaginal opening.
FGM Type 4 – Gishiri cuts – all other types including pricking, cutting and piercing, inserting substances with any of the above.

Background

FGM is a tradition practiced in 28 African countries and parts of Asia and Latin American. The communities with the highest prevalence are generally from the Horn of Africa and include countries such as Somalia, Egypt, Mali, Guinea etc (C Momoh (2005) Female Genital Mutilation, Radcliffe, Oxford). Appendix 1 gives the geographical prevalence data related to FGM.

FGM is increasingly found in Western Europe and developed countries. In the UK there are populations of people from countries who practice FGM, some of these populations have settled in the South West. They maintain close cultural links to their country of origin. The women and girls in these families are at risk of FGM.

In the UK it has been estimated that up to 100,000 women and up to 10,000 children are at risk.

Many women, men and professionals appear to be unaware of the major health issues associated with FGM. The physical and mental trauma usually causes long term complications for these women. These include:

Incontinence
Chronic renal infection
Painful sexual intercourse
Infertility is common
Difficulty with childbirth
Emotional and behavioural problems
The procedure is associated with death from infection and haemorrhage

(See Appendix 2 for more information relating to the short and long term complications from FGM)

Justification for FGM

Reason given by communities for practicing FGM includes:

Custom and tradition;
Family honour;
Hygiene and cleanliness;
Preservation of virginity/chastity;
Social acceptance especially for marriage;
The mistaken belief that it is a religious requirement;
A sense of belonging to the group and conversely the fear of social exclusion

In the UK the complexities of the social interactions that surround this practice have led to collusion and secrecy within families when they are planning for FGM. This poses a huge challenge for staff who need to identify these risks and protect girls from FGM.

Signs & Indicators

Some indicators that FGM may be about to or has already taken place.

If a family originates from a country that is known to practice FGM and:

A conversation with a child may refer to FGM i.e. she may express anxiety about a ‘special procedure’, ‘pricking’, ‘pinching my bottom’ or an event or celebration that is to take place.
At school following a prolonged absence you may notice a change in the child’s behaviour on their return, including a reluctance or inability to take part in physical activity.
A prolonged family trip to the country of origin or countries where FGM is practiced.
A child may spend long periods of time visiting the toilet during the day-perhaps indicating bladder or menstrual problems.
A midwife/obstetrician/gynaecologist/general practitioner/practice nurse may become aware that FGM has occurred when treating a female patient. This should trigger concern for other females in the household.

All agencies have a responsibility to recognise the signs and indicators and share and report information appropriately, but Education and Health need to be especially vigilant.

Policy

LSCBs recognise that there may be no intent to harm a child through FGM. FGM does however cause serious physical and mental and emotional complications to the health of the girl and is regarded as a form of Physical Abuse.

The aim is to prevent the practice of FGM in a culturally sensitive manner with the greatest involvement of community representatives and professional groups as is possible.

All agencies involved in the safeguarding and protection of children should be fully aware of FGM and have a policy within their own organisation. There should be a preventative strategy with a focus on education and training as well as protection of those at risk from harm.

See flowchart

Practical Guidelines

If a person has any concerns related to a girl being at risk of FGM then they should follow the flow chart above, which supports guidance from the following; ‘Working Together to Safeguard Children 2006’.

Children identified to be at risk of FGM should be referred to Social Care or the Police. Social Care will consult the Community Paediatrician and the Police’s Child Abuse Investigation Team following these initial concerns. This is called a strategy discussion, the gateway to the Child Protection Procedures.
The strategy discussion is initially to identify which professional is best placed to talk to parents. Language difficulties and the use of interpreters should also be considered.
The agenda should include risk to any siblings now or in the future, getting intelligence on the person undertaking the FGM procedure, the immediate health needs of the child and consider prosecution.
It is best practice to gain Parental consent but if this puts the child or other children in the family at risk then the referral should be made without consent.
FGM places a child at risk of significant harm and will therefore be investigated under section 47 of the Children Act 1989.

Case Guidance

New referrals should be managed according to the following guidelines:

An appropriately qualified female interpreter skilled in addressing issues of language, race and culture must be used. It is important to gauge the views of the interpreter towards FGM before they are used to support families.
Every attempt should be made to work with parents on a voluntary basis to prevent the abuse. It is the duty of the investigating team to look at every possible way that parental co-operation can be achieved. Working sensitively within cultural and language parameters is also a priority
If no agreement is reached, the first priority is the protection of the child and the least intrusive legal action should be taken to ensure the child’s safety.
A child thought to be in immediate danger of FGM where the parents are unable to ensure the safety of the child will need an Emergency Protection Order (EPO).
A Prohibited Steps Order can be sought to stop parents who have decided to send the child overseas and mutilation is likely to take place.
Where there is no immediate danger to the children counselling and education clarifying the dangers and legal issue related to FGM for parents should be arranged.
Wherever possible the child would remain in the family and all the principles of good child protection work apply equally to this situation.
The primary focus is to prevent the child undergoing any form of FGM rather than removal from the family.

Children Who Have Undergone FGM

If a child has already undergone FGM and this comes to the attention of any professional, a referral should be made to Social Care or the Police Child Abuse Investigation Team. A strategy discussion will be convened to consider, how, where and when the procedure was performed and its implications for other female children in the family. If FGM has been undertaken in the UK or to a British National overseas after 2003, the police will investigate and prosecution will be considered.

A child who has undergone FGM will be seen as a child in need and offered services as appropriate. Medical assessment and both short term and long term therapeutic services are to be considered at the strategy meeting.

If a Woman Has Already Undergone FGM

If a woman has already undergone FGM and this comes to the attention of any professional e.g. midwife, GP or practice nurse, consideration needs to be given to any child protection implications e.g. for female siblings, their children and their family members. The professional must consider a referral to Social Care and share and document information appropriately.

If the woman is the mother of a female child or has the care of female children, professionals need to assess the potential risk to female children in the family and need to identify the most appropriate way of informing parents of the legal and health implications of FGM. This should be done in consultation with Social Care and an appropriately trained interpreter who has an understanding of FGM, the law and cultural sensitivity.

Prevention and Training

FGM should be discouraged through appropriate educational and preventative programmes aimed at all communities, but especially those who are known to practice FGM.
Professionals working in child protection should be aware of local preventative work relating to FGM in their locality. In the South West services are currently being developed.
Schools and social care can draw up partnership agreements with parents. This would make explicit that the girl is not sent back to country of origin for FGM and parents are aware of the law. If the girl is suspected to have undergone FGM, then the terms of the agreement have been broken.

LSCBs should organise training

It is essential that each agency encourages appropriate staff to attend these training sessions.

All major single agencies (Police, Social Care, Health and Education) should undertake their own specific in house training related to FGM and this should be offered to all staff but targeted to staff working in areas of higher risk.

The training should include knowledge of the guidelines, recognising signs and symptoms of FGM being planned or having been performed, how to make a referral, and how to access support for victims of FGM.

For further reading and support see references, bibliography and local services.

References

HMSO (2003)

The Female Genital Mutilation Act (2003) http://www.opsi.gov.uk/ACTS/acts2003/20030031.htm

Royal College of Nursing (2006) (RCN)

Female Genital Mutilation Guidelines: An RCN educational resource for nursing and midwifery staff.

DfES (2006)

Working Together to Safeguard Children, HMSO, Norwich

The Children Act (1989 & 2004)

HMSO, London

Agency for Culture and Change Management

South Yorkshire (2005)

Female Genital Mutilation Guidelines

Area Child Protection Procedures

C Momoh (2005)

Female Genital Mutilation, Radcliffe, Oxford

Services

Organisations & Support Groups

Agency for Culture & Change Management (ACCM)

The Old Coroners Court

14/18 Nursery Street

Sheffield

S3 8GG

Tel: 0114 275 0193

www.accmsheffield.org

Black Women’s Health and Family Support (BWHAFS)

82 Russia Lane

London

E2 9LU

Tel: 020 8980 3503

www.bwhafs.com

bwhafs@btconnect.com

WoMan being Concern International

K405 Tower Bridge Business Complex

100 Clements Road

London

SE16 4DG

Tel: 020 7740 1306

www.womanbeing.org

National & International Groups

FORWARD (Foundation for Women’s Health, Research and Development)

Unit 4

765 – 767 Harrow Road

London

NW10 5NY

Tel: 020 8960 4000

www.forwarduk.org.uk

forward@forwarduk.org.uk

Appendix 1

Female Genital Mutilation Appendix 1

28 African countries, and FGM prevalence data for some of these countries

Guinea Bissau	local	clitoridectomy and excision
Kenya	50%	clitoridectomy, excision and some infibulation
Liberia	50%	excision
Mali	94%	clitoridectomy, excision and infibulation
Mauritania	25%	clitoridectomy and excision
Niger	local	excision
Nigeria	60 – 90%	clitoridectomy, excision, some infibulation
Senegal	20%	excision
Sierra Leone	90%	excision
Somalia	98%	infibulation
Sudan	90%	infibulation and excision
Tanzania	18%	infibulation and excision
Togo	12%	excision
Uganda	local	clitoridectomy and excision

Based on statistics from Amnesty International and US govt.

For a detailed list of African countries that practice FGM, the type of FGM practiced, their prevalence and their laws, go to FORWARD’s website and review ‘FORWARD FGM information pack pages 7-9′ link below:

http://www.forwarduk.org.uk/key-issues/fgm

Appendix 2

Female Genital Mutilation Appendix 2

Short Term Health Implications

Severe pain and shock
Infections
Urine retention
Injury to adjacent tissues
Fracture or dislocation as a result of restraint
Damage to other organs
Behavioural changes and emotional upset
Death

Long Term Health Implications

Recurrent Urinary Tract Infections
Excessive damage to the reproductive system
Uterus, vaginal and pelvic infections
Difficulties in menstruation
Difficulties in passing urine
Increased risk of HIV transmission and Hepatitis B
Infertility
Cysts
Complications in pregnancy and childbirth
Psychological damage
Sexual dysfunction

Flowchart