In the UK female genital mutilation (FGM) has been illegal since 1985. Since 31 October 2015 health and social care professionals and teachers have a legal obligation to report any cases of FGM of children to the police. FGM is a serious crime and a child protection issue.
What is Female Genital Mutilation (FGM)?
Female genital mutilation includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. It is a procedure that has no health benefits for girls and women and can cause severe bleeding, problems urinating, cysts, infections, infertility as well as complications in childbirth and increased risk of new born deaths.
FGM is illegal unless it is a surgical operation which is necessary for a patient's physical or mental health or the patient is at any stage of labour, or has just given birth, for purposes connected with the labour or birth. It is also illegal to arrange, or assist in arranging, for a UK national or UK resident to be taken overseas for the purpose of FGM and those with parental responsibility who fail to protect a girl from the risk of FGM also commit an offence.
Who is affected?
More than 140 million girls and women have been subjected to FGM in the 29 countries in Africa and Middle East where FGM is concentrated. It is a procedure mostly carried out on young girls sometime between infancy and age 15 and is in the UK a violation of the human rights of girls and women. The majority of cases of FGM are thought to take place between the ages of five and eight. In England and Wales it is estimated that 137,000 women including 10,000 girls aged under 15 years, born in countries where FGM is traditionally practised, have undergone FGM.
Duties of health and social care professionals and teachers in cases involving children
FGM has been a specific criminal offence since the Prohibition of Female Circumcision Act 1985 came into force in September 1985. This Act was replaced and revised by the Female Genital Mutilation Act 2003. The Female Genital Mutilation Act 2003 was amended by sections 70 to 75 of the Serious Crime Act 2015. These amendments place a mandatory duty on health and social care professionals and teachers to report cases of FGM in under 18s to the police.
The duty to report:-
- arises where the professional is informed by the girl that she has undergone an act of FGM or they observe physical signs that FGM may have been carried out on a girl under the age of 18. The relevant age is the girl's age at the time of the disclosure/identification.
- does not require there to be a full clinical diagnosis. One should not be carried out unless the case is identified as part of an examination already underway.
- does not apply if anyone other than the victim eg parent/guardian/sibling discloses that a girl under 18 has had FGM. Any such disclosure should be handled in line with wider safeguarding responsibilities.
- does not breach any confidentiality requirement. A failure to do so may put a professional's registration at risk.
- is a personal individual duty which means that it cannot be transferred. However it does not apply if the professional can identify that another individual working in the same profession has already made a report to the police in connection with the same act of FGM
- does not apply to a non-pregnant woman with FGM over the age of 18 unless a related child is at risk. In relation to pregnant women a member of the clinical team (midwife or obstetrician) must make an individual risk assessment using an FGM safeguarding risk assessment tool and if the unborn child, or any other child in the family, is considered to be at risk of FGM then it is necessary to report to social services or the police. Maternal history of FGM in the personal child health record prior to postnatal discharge should be documented. If a pregnant woman with FGM delivers a baby girl the designated child protection midwife should be notified who should then inform the GP and the health visitor.
There is a useful flowchart (Annex A) and FAQs (Annex B) attached to the Home Office guidance – Mandatory Reporting of Female Genital Mutilation – procedural information.
Reporting to police and/or social services in the event of risks to a child
- Referral - In relation to a child under 18, if FGM is confirmed, the matter should be referred to the police immediately. The legislation requires the report to the police to identify the girl and an explanation of why the report is being made. If FGM is suspected or the girl is at risk, the matter should be referred to social services or the police
- Record keeping – Throughout the process a comprehensive record should be kept. Ensure that you obtain a reference number from the police. The designated safeguarding lead should also be kept updated as appropriate.
- Time frame - There is a maximum timeframe of 1 month from when the discovery was made for exceptional cases where for example a professional has concerns that a report to the police may result in a safeguarding risk to the child or another child. If so consult the designated safeguarding lead and keep a record of any decisions made.
- Information sharing – the girl and /or her parents should be contacted to explain the report unless this may result in a risk of serious harm to the child or anyone else.
- After a report has been made responsibilities of health professionals include responding to the physical and psychological needs of the girl.
There have notably been no successful prosecutions of people who perform FGM in the UK. In February 2015 a doctor was accused of carrying out the illegal procedure and a second man was accused of aiding and abetting him. Both men were acquitted.
What can Trusts do to assist those at risk/those affected by FGM?
- Involve individuals affected by FGM and experts. For example the Midaye Somali community, maternity services and children's services are brought together in the FGM service at St Mary's Hospital London. Maternity services or GPs refer women to the clinic and therapy and psychological support can be accessed here.
- Early identification and referral.
- Good record keeping
- Sharing information
Multi- Agency Practice Guidelines – Female Genital Mutilation 6 June 2014 – HM Government
Female Genital Mutilation and its Management 10 July 2015 RCOG
Female genital mutilation - legislation, policy and guidance - NSPCC
Factsheet – female genital mutilation Gov.uk
Mandatory Reporting of Female Genital Mutilation – procedural information – Home Office