4.2 Female Genital Mutilation
- Factors indicating girls are at risk of FGM
- Mandatory reporting of FGM
- What to do if a child is suspected to be at risk of FGM
- Further information
- Local information
FGM is child abuse and a form of violence against women and girls, and therefore should be dealt with as part of existing child and adult safeguarding/protection structures, policies and procedures.
The practice is illegal in the UK and it is also illegal to take a British national or permanent resident abroad for the practice of FGM or to help someone trying to do this.
Female genital mutilation comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.
FGM is known by a variety of names, including ‘female genital cutting’, ‘circumcision’ or ‘initiation’. The term ‘female circumcision’ is anatomically incorrect and misleading in terms of the harm FGM can cause. The terms ‘FGM’ or ‘cut’ are increasingly used at a community level, although they are not always understood by individuals in practising communities, largely because they are English terms.
The World Health Organization (WHO) has classfied FGM into four types:
- Type 1 - Clitoridectomy: 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);
- Type 2 - Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are the 'lips' that surround the vagina);
- Type 3 - Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris; and
- Type 4 - Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterising the genital area.
Factors indicating girls are at risk of FGM
The most significant factor to consider when deciding whether a girl or woman may be at risk of FGM is whether her family has a history of practising FGM. In addition, it is important to consider whether FGM is known to be practised in her community or country of origin.
The age at which girls undergo FGM varies enormously according to the community. The procedure may be carried out when the girl is new-born, during childhood or adolescence, at marriage or during a first pregnancy.
There are a number of factors in addition to a girl’s or woman’s community, country of origin and family history that could indicate she is at risk of being subjected to FGM. Department of Health guidance on FGM risk and safeguarding include the following risk factors for girls aged under 18 years:
- Child’s mother has undergone FGM
- Other female family members have had FGM
- Father comes from a community known to practice FGM
- A female family elder is very influential within the family and is/will be involved in the care of the girl
- Mother/family have limited contact with people outside of her family
- Parents have poor access to information about FGM and do not know about the harmful effects of FGM or UK law
- Parents say that they or a relative will be taking the girl abroad for a prolonged period – this may not only be to a country with high prevalence, but this would more likely lead to a concern
- Girl has spoken about a long holiday to her country of origin/another country where the practice is prevalent
- Girl has attended a travel clinic or equivalent for vaccinations/anti-malarials
- FGM is referred to in conversation by the child, family or close friends of the child
- Sections missing from the Red book. Consider if the child has received immunisations, do they attend clinics etc.
- Girl withdrawn from PHSE lessons or from learning about FGM
- Family not engaging with professionals (health, school, or other)
- Any other safeguarding alert already associated with the family
Significant or immediate risk factors are:
- A child or sibling asks for help
- A parent or family member expresses concern that FGM may be carried out on the child
- Girl has confided in another that she is to have a ‘special procedure’ or to attend a ‘special occasion’. Girl has talked about going away ‘to become a woman’ or ‘to become like my mum and sister’
- Girl has a sister or other female child relative who has already undergone FGM
- Family/child are already known to social services.
The signs that a girl under 18 years has has FGM include:
- Girl is reluctant to undergo any medical examination
- Girl has difficulty walking, sitting or standing or looks uncomfortable
- Girl finds it hard to sit still for long periods of time, which was not a problem previously
- Girl presents to GP or A&E with frequent urine, menstrual or stomach problems
- Increased emotional and psychological needs e.g. withdrawal, depression, or significant change in behaviour
- Girl avoiding physical exercise or requiring to be excused from PE lessons without a GP’s letter
- Girl has spoken about having been on a long holiday to her country of origin/ another country where the practice is prevalent
- Girl spends a long time in the bathroom/toilet/long periods of time away from the classroom
- Girl talks about pain or discomfort between her legs
Mandatory reporting of FGM
Healthcare professionals must report to the police any cases of female genital mutilation (FGM) in girls under 18 that they come across in their work. This duty came into force on 31 October 2015.
This duty applies to regulated health and social care professionals and teachers in England and Wales. It requires these professionals to make a report to the police if, in the course of their professional duties, they:
- are informed by a girl under 18 that an act of FGM has been carried out on her; or
- observe physical signs which appear to show that an act of FGM has been carried out on a girl under 18 and 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.
For further information, see the Government’s information on FGM reporting.
What to do if a child is suspected to be at risk of FGM
If one or more indicators for FGM are identified, the professional should consider whether the level of risk requires referral. It should be discussed with the named/designated safeguarding lead.
If one or more serious or immediate risk are idenitified, or the other risks are sufficient to be considered serious, a referral should be made in accordance with the Referral procedure. If the risk of harm is imminent, emergency measures may be required and any action taken must reflect the required urgency.
Any child under 18 who has undergone FGM must be referred to police under the Mandatory Reporting duty using the 101 non-emergency number.
- Tackling Female Genital Mutilation in Hampshire: A partnership approach – 2016-2019
- Tackling FGM on the Isle of Wight: A partnership approach (under review)
- Statutory guidance on Female Genital Mutilation.
- FGM Protection Orders: Factsheet
- Female Genital Mutilation and its Management: Royal College of Obstetricians and Gynaecologists 2015
- Mandatory Reporting of Female Genital Mutilation
- Safeguarding Women and Girls at Risk of FGM
- Statement Opposing Female Genital Mutilation (Health Passport)
Hampshire Safeguarding Children Partnership FGM resources:
- FGM Mandatory Reporting Duty – Under 18 Years
- FGM Reporting Duty – Over 18 Years
- FGM Prevalence Map
- Risk Assessment for Female Genital Mutilation/Cutting