RELEVANT SECTIONS AND CHAPTERS
This chapter was added to the MAPP in November 2018.
Female Genital Mutilation (FGM is practised by families for a variety of complex reasons but often in the belief that it is beneficial for the girl or woman. It is the mutilation of the labia majora, labia minora or clitoris.
FGM is prevalent in 28 African countries as well as in parts of the Middle East and Asia. It is usually performed on younger children and girls, but young adult women may also be at risk. FGM constitutes a form of child abuse and violence against women and girls, and has severe short and long term physical and psychological consequences.
There are an estimated 103,000 women aged 15-49 and approximately 24,000 women aged 50 and over who have migrated to England and Wales who are living with the consequences of FGM. In addition, approximately 10,000 girls aged under 15 are also likely to have undergone FGM. It is illegal in the UK.
2. Effects of Female Genital Mutilation
There are no health benefits to FGM. Removing and damaging healthy and normal female genital tissue interferes with the natural functions of girls’ and women’s bodies.
2.1 Immediate effects
- severe pain;
- wound infections, including tetanus and gangrene, as well as blood borne viruses such as HIV, hepatitis B and hepatitis C;
- inability to urinate;
- injury to vulval tissues surrounding the entrance to the vagina;
- damage to other organs nearby, such as the urethra (where urine passes) and the bowel.
FGM can sometimes cause death.
2.2 Long term consequences
- chronic vaginal and pelvic infections;
- abnormal periods;
- difficulty passing urine, and persistent urine infections;
- kidney impairment and possible kidney failure;
- damage to the reproductive system, including infertility;
- cysts and the formation of scar tissue;
- complications in pregnancy and newborn deaths;
- pain during sex and lack of pleasurable sensation;
- psychological damage, including low libido, depression and anxiety;
- flashbacks during pregnancy and childbirth;
- the need for later surgery to open the lower vagina for sexual intercourse and childbirth.
Personal accounts indicate that FGM is an extremely traumatic experience for girls and women, the effects of which remain with them throughout their life. Young women may feel betrayed by their parents, as well as experience regret and anger.
3. Action in Suspected Cases
Young women are often taken back to their country of origin for this procedure. On returning home there may be changes to their behaviour including ill health, depression and withdrawal.
If a young adult / adult woman has recently had FGM or a professional suspects that such a procedure may be performed, it should be reported to the police and to adult social care (see Stage 1: Alert).
Professionals should ensure that they make a full record of all discussions, with whom these take place and any actions taken including referrals to other agencies. They should also inform their line manager who should sign off discussions and actions (see also Record Keeping).
There is, however, no requirement for an automatic referral of an adult woman who has already had FGM to adult social care or the police. Professionals should be aware that a disclosure may be the first time that a woman has discussed her FGM with anyone. Referral to the police must not be introduced as an automatic response when an adult woman with FGM has been identified. Each case must be assessed individually. The wishes of the woman must be respected at all times.
The professional involved should support the woman by offering referral to community groups for support, clinical intervention or other services as appropriate, for example to an NHS FGM clinic.
If the woman is pregnant the welfare of an unborn female child must be considered, as should any female child in the family or extended family. Young female relatives of women who have already had FGM performed may be more likely to suffer significant harm as a result of a similar procedure carried out on them, therefore action must be taken to safeguard them by referring to children’s social care and / or the police. See Local Safeguarding Children Board Procedures for further information – customer to provide link.
4. Mandatory Reporting Programme for Health Professionals
In relation to adults NHS England states: ‘There is no requirement for automatic referral of adult women with FGM to adult social services or the police. Healthcare professionals should be aware that a disclosure may be the first time that a woman has discussed her FGM with anyone. Referral to the police must not be introduced as an automatic response when identifying adult women with FGM, and each case must continue to be individually assessed. The healthcare professional should seek to support women by offering referral to community groups for support, clinical intervention or other services as appropriate, for example through an NHS FGM clinic. The wishes of the woman must be respected at all times. If she is pregnant, the welfare of her unborn child or others in her extended family must also be considered at this point as they are potentially at risk and action must be taken accordingly.’
The NHS link above also includes information about the mandatory reporting programme for all cases of FGM. It is now mandatory to record FGM in a patient’s healthcare record and submit anonymised monthly data to the Department of Health and Social Care.
It is now mandatory to record FGM in a patient’s healthcare record and submit anonymised monthly data to the Department of Health and Social Care. For further information see Female Genital Mutilation Prevention Programme: Requirements for NHS staff: Statement by the Department of Health and Social Care and NHS England.