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4.21 Female Genital Mutilation

RELATED GUIDANCE

For further information see ‘Multi-agency statutory guidance on female genital mutilation’ (GOV.UK, 2016)

RELATED CHAPTER

Female Genital Mutilation Multi-Agency Protocol

AMENDMENT

This chapter was updated in May 2017 to add a link to the Multi-agency statutory guidance on female genital mutilation (GOV.UK, 2016) – see above in Related Guidance.


Contents

  1. Introduction
  2. Cultural Sensitivity
  3. Referral
  4. Liaison with Merseyside Police
  5. Assessment
  6. Useful Organisations


1. Introduction

Female genital mutilation (FGM) is a collective term for procedures which include the removal of part or all of the external female genitalia for cultural or other non-therapeutic reasons. The practice is medically unnecessary, extremely painful and has serious health consequences, both at the time when the mutilation is carried out and in later life. The procedure is typically performed on girls aged between 4 and 13, but in some cases it is performed on newborn infants or on young women before marriage or pregnancy.

FGM has been a criminal offence in the U.K. since the Prohibition of Female Circumcision Act 1985 was passed. The Female Genital Mutilation Act 2003 replaced the 1985 Act and makes it an offence for the first time for UK nationals or permanent UK residents to carry out FGM abroad, or to aid, abet, counsel or procure the carrying out of FGM abroad, even in countries where the practice is legal.

It is reportedly practised in 28 African countries and in parts of the Middle and Far East, but it is increasingly found in Western Europe and other developed countries primarily among immigrant and refugee communities.

NHS Actions

From April 2014 NHS hospitals will be required to record:

  • If a patient has had Female Genital Mutilation;
  • If there is a family history of Female Genital Mutilation;
  • If a Female Genital Mutilation-related procedure has been carried out on a patient.
From September 2014 all acute hospitals must report this data centrally to the Department of Health on a monthly basis. This is the first stage of a wider ranging programme of work in development to improve the way in which the NHS will respond to the health needs of girls and women who have suffered Female Genital Mutilation and actively support prevention.


2. Cultural Sensitivity

Investigating agencies need to be sensitive to the cultural beliefs surrounding FGM and should consult with cultural community groups (see Section 6, Useful Organisations). However, professionals should not let fears of being branded 'racist' or 'discriminatory' weaken the protection required by vulnerable girls and women.

FGM is much more common than is generally realised both worldwide and in the U.K. It is deeply embedded in the culture of the practising community who may resent what they perceive as the imposition of liberal western values on them, but it is not a matter which can be left to personal preference or culture and custom. FGM is an extremely harmful practice that violates the most basic human rights. However, any community education should be sensitive to the cultural norms and pressures on parents and children.

It may be most useful to try to engage community groups and elders or religious leaders in community education programmes. It is extremely important that those running programmes are not seen as alien to the practice. This may create animosity and paranoia within the practising communities and make it harder to safeguard children from FGM.

For many families English may not be their preferred language, the assistance of an independent interpreter needs to be considered - see Use of Interpreters, Signers or Others with Communication Skills Procedure. Any interpreter should be appropriately trained in relation to FGM and should not be a family member, not be known to the individual, and not be an individual with influence in the individual's community. This is because girls or women may feel embarrassed to discuss sensitive issues in front of such people and there is a risk that personal information may be passed on to others in their community and place them in danger

The guidance recommends that a female professional be available to speak to if the girl or woman would prefer this.


3. Referral

If any agency becomes aware of a child who may have been subjected to or is at risk of FGM they must make a referral to Children's Specialist Services using the Contacts and Referrals Procedure.

Suspicions may arise in a number of ways that a child is being prepared for FGM to take place abroad.

All professionals need to consider whether any other indicators exist that FGM may have or has already taken place, for example:

  • Preparations are being made to take a long holiday - arranging vaccinations or planning an absence from school;
  • The child has changed in behaviour after a prolonged absence from school; or
  • The child has health problems, particularly bladder or menstrual problems.

There may be older women in the family who have already had the procedure and this may prompt concern as to the potential risk of harm to other female children in the same family. Younger female siblings must also be considered. Any girl withdrawn from Personal, Social and Health Education or Personal and Social Education may be at risk as a result of her parents wishing to keep her uninformed about her body and rights.

On receipt of a referral, a strategy meeting must be convened as soon as practicable (and in any case within two working days), and should involve representatives from the police, Children's Specialist Services, education professionals, and health services.

The Strategy Meeting must first establish whether the parents or girl has had access to information about the harmful aspects of FGM and the law in the UK. If not, they should be given appropriate information regarding the law and harmful consequences of FGM.

Where a girl has already undergone FGM, a second strategy meeting should take place within ten working days of the referral. This meeting must evaluate the information collected in the enquiry and recommend whether a child protection conference is necessary to make a decision about whether the girl continues to be suffering or likely to suffer Significant Harm and needs further protection, and possibly to agree a child protection plan.

A girl who has already undergone FGM should not normally be subject to a child protection conference or be included on the child protection register unless additional child protection concerns exist. However, she should be offered counselling and medical help, and consideration should be given to any other female siblings at risk.

Children's Specialist Services will liaise with the Paediatric services where it is believed that FGM has already taken place to ensure that a Medical Assessment takes place.

It should be remembered that this is a one-off act of abuse to a child, although it will have lifelong consequences, and can be highly dangerous at the time of the procedure and directly afterwards.


4. Liaison with Merseyside Police

Children's Specialist Services will refer the matter to Merseyside Police Family Crime and Investigation Unit who will participate in the investigation and consult with the Forensic Medical Examiner.


5. Assessment

Children's Specialist Services in consultation with the Police will undertake a Section 47 Enquiry if it has reason to believe that a child is likely to suffer or has suffered FGM.

Where a child has been identified as suffering or likely to suffer Significant Harm, it may not always be appropriate to remove the child from an otherwise loving family environment. Parents and carers may genuinely believe that it is in the girl's best interest to conform to their prevailing custom. The preferred outcome for the child is that the family agree to halt the process. Therefore the main emphasis of work in cases of actual or threatened FGM should be through education and persuasion.

Where a child appears to be in immediate danger of mutilation, legal advice should be sought and consideration should be given, for example, to seeking an Emergency Protection Order or a Prohibited Steps Order, making it clear to the family that they will be breaking the law if they arrange for the child to have the procedure.


6. Useful Organisations

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