Introduction
Female genital mutilation (sometimes referred to as female circumcision) refers to procedures that intentionally alter and cause injury to the female genital organs for non-medical reasons. It is illegal in the UK.
Female genital mutilation (FGM) is a painful, non-medical procedure undertaken on girls and young women which can seriously harm their long-term health. It is a form of child abuse that is illegal in the UK. It’s estimated over 60,000 young women under 15 may be at risk of FGM in England and Wales each year, and approximately 137,000 women and girls are living with the consequences of FGM. The true extent is unknown due to the ‘hidden’ nature of the crime. The NHS FGM annual report identified 5,395 cases in England in 2020-2021.
Young women may be taken to another country to be mutilated during the summer holidays. Some young women may be abused in the UK. The procedure is traditionally carried out by a woman with no medical training. Anaesthetics and antiseptic treatments are not generally used, and girls may have to be forcibly restrained.
FGM is part of a group of abusive practices known collectively as harmful practices.
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Definition of FGM
FGM comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs. It is illegal in the UK and a form of child abuse with long-lasting harmful consequences.
Your responsibilities
If you believe there is a risk of FGM you must notify children’s social care immediately, without seeking consent from the family.
The Serious Crime Act 2015 amended the FGM Act 2003 to introduce a mandatory duty on all teachers and registered health and social care professionals (in England and Wales) to notify the police of any “known” cases (those where either a girl informs the person that an act of FGM – however described – has been carried out on her, or where the person observes physical signs on a girl appearing to show that an act of FGM has been carried out) where FGM has taken place on a child (i.e., anyone under the age of 18). If you fall into one of these categories it is therefore your duty to report it directly to the police, as well as notifying your designated safeguarding lead. The duty does not apply where there are concerns that a child may be at risk of FGM.
With regards to the “observing of physical signs”, the guidance notes that it will be rare for most professionals to see visual evidence (other than when, for example, they provide intimate care for a child such as nappy changing or assistance with toileting) and they should not be examining children.
FGM is abuse. Courts may make FGM Protection Orders which aim to protect specific children from being harmed.
More information
FGM can take place at any age from infancy upwards, often when new-born, during childhood or adolescence, just before marriage, or during pregnancy. It’s also known as “female circumcision” or “cutting”, and by other terms such as Sunna, gudniin, halalays, tahur, megrez and khitan, among others. There are no health benefits, but there are risks of serious harm both in the short and long term.
Countries that have significantly high numbers of cases include Somalia, Egypt, the Sudan, Malaysia and Mali.
FGM can cause severe pain, bleeding, wound infections, inability to urinate, injury to vulval tissues, damage to other organs and sometimes death. Other complications can arise later with the onset of puberty.
Types of FGM
There are four types of FGM:
- type 1 – clitoridectomy – removing part or all of the clitoris and/or the clitoral hood;
- type 2 – excision – removing part or all of the clitoris and the inner labia (lips that surround the vagina), with or without removal of the labia majora (large outer lips);
- type 3 – infibulation – narrowing the vaginal opening by creating a seal, formed by cutting and repositioning the labia, with or without removal of the clitoris;
- type 4 – other harmful procedures to the female genitals, including pricking, piercing, cutting, scraping or burning the area.
It is estimated 200 million girls and young women globally have been subject to FGM, of these around 44 million are aged under 15.
Additional vulnerabilities
FGM only affects girls. Girls are potentially at risk when/if, for example:
- they are born to a woman who has undergone FGM;
- they have an older sibling or cousin who has undergone FGM;
- one or both of their parents and/or elder family members consider FGM integral to their cultural or religious identity;
- their family indicates that there are strong levels of influence held by pro-FGM elders who are involved in bringing up their female children;
- they or their family have a limited level of integration within the UK community;
- their parents ask for them to be withdrawn from PSHE and R(S)E and/or they tend to be absent on days that it is taught;
- they talk about FGM or needing to have a ‘special procedure’ or to attend a special occasion (possibly to ‘become a woman’).
Spot the signs
Signs that FGM has been carried out may include:
- constant pain;
- repeated infections;
- problems passing urine;
- incontinence;
- bleeding, cysts, abscesses;
- pain during sex;
- depression, flashbacks;
- sleep problems;
- self-harm;
- difficulties participating in PE classes.
Later in life, women may experience difficulties becoming pregnant and those who do conceive may have significant problems with childbirth.
Signs that it might be about to happen include girls whose families originate from an FGM practising community (especially where their parents or elder members of the family feel FGM is part of their cultural/religious identity) include:
- travelling to certain countries (especially during the summer holidays) in Africa, the Middle East and Asia, e.g., for a special occasion/ceremony.
- talking about (or someone else says about them) someone coming to see them for a special ceremony (e.g., to 'become a woman').
- parents saying they (or a relative) are taking the girl out of the country for a prolonged period and are evasive about why.
- requesting help from a teacher or another adult because they are aware or suspect that they are at immediate risk of FGM.
What to do
Where there is concern that a girl is at risk of FGM, you should inform your designated safeguarding lead, and a referral should be made to children’s social care. If the girl is in imminent danger, the police should be called on 999 immediately.
If a girl discloses, or it is suspected that she has already undergone FGM, you must inform your designated safeguarding lead. As above, teachers in England and Wales must also refer ‘known’ cases to the police on 101 under the mandatory reporting duty. The girl should be offered medical help and counselling. Action should also be taken to protect any other girls in the family and to investigate possible risks to others in the community.
We should not rely on young people to identify their own abuse – often they don’t know they are being abused or are unable to tell us for whatever reason. In the case of FGM, they may not even remember it being done if it took place when they were an infant.
Ensure young people know the risks – talk about FGM at an age-appropriate level from the later years of primary school in the same way we do about drugs and other issues
Ensure your setting’s approach to safeguarding against FGM is multi-agency and multi-disciplinary. They should work with partners in social services, health and the police.
Check young people have safe relationships – in their families, with their peers and with your staff. Create an environment where it’s okay to talk even about the most difficult things.
Spot the signs and know what to do – use the checklists above, your safeguarding procedures and be confident in raising FGM as a possibility.
Take action – and keep taking action until you know girls and young women are safe.
Resources
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Multi-agency statutory guidance on female genital mutilation
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Home Office female genital mutilation resource pack
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Mandatory reporting of female genital mutilation: procedural information
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National FGM Centre resources
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