It’s devastating to learn that an estimated 200 million girls and women worldwide have undergone some form of female genital mutilation (FGM) – many before the age of 15. Despite being internationally recognised as a human rights violation, FGM persists for various reasons. But no matter where or how it’s performed, FGM causes extreme physical and psychological harm.

What is FGM?

Female genital mutilation refers to all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons. It’s most often carried out on young girls between infancy and their teens. It’s vital to remember, though, that in every form in which it’s practised, FGM is a violation of girls’ and women’s fundamental human rights, including their rights to health, security and dignity.

In what ways is FGM a risk?

FGM has no health benefits whatsoever and can lead to serious, long-term complications and even death. Immediate health risks include haemorrhage, shock, infection, HIV transmission, urine retention and severe pain.

Psychological impacts can range from a girl losing trust in her caregivers, to longer-term feelings of anxiety and depression.

In adulthood, girls subjected to FGM are more likely to suffer infertility or complications during childbirth, including postpartum haemorrhage, stillbirth and early neonatal death.

Does FGM happen in the UK?

FGM has been illegal in the UK since 1985 and is considered a form of child abuse. However, it’s only been tracked by the NHS since 2015 so it’s hard to accurately calculate the number of girls and women who have suffered FGM. According to the statistics released by NHS Digital in July 2020, the worrying news is that there were 6,590 women and girls who had either had a procedure to treat their FGM or were identified as having undergone FGM previously when treated between April 2019 and March 2020.

Legislation

As in many European countries, girls whose families originate from an FGM-practising community are at greater risk of FGM happening to them, particularly during the summer holidays when they may be taken abroad for the procedure. Penalties for anyone in the UK who performs FGM include up to 14 years in prison, and anyone found guilty of failing to protect a girl from FGM can face up to seven years in prison.

What to do if you are concerned

If you believe a girl has been recently cut, or is at imminent risk, it is important to act immediately and call 999.  The police will assist with the next steps in support and management. An NHS guidance document sets out the steps to follow should you suspect there is a risk of FGM, or there is evidence of this happening to a patient. It’s vital to follow the steps set out here.

In summary

• FGM is illegal in the UK. For the purpose of the criminal law in England and Wales, FGM is mutilation of the labia majora, labia minor or clitoris.
• FGM is an unacceptable practice for which there is no justification. It’s child abuse and a form of violence against women and girls.
• FGM is prevalent in 30 countries. These are concentrated in countries around the Atlantic coast to the Horn of Africa, in areas of the Middle East, and in some countries in Asia.
• It’s estimated that approximately 103,000 women aged 15-49, and approximately 24,000 women aged 50 and over, who have migrated to England and Wales are living with the consequences of FGM. In addition, approximately 10,000 girls aged under 15 who have migrated to England and Wales are likely to have undergone FGM.
• FGM is a deeply embedded social norm, practised by families for a variety of complex reasons. It’s often thought to be essential for a girl to become a proper woman, and to be marriageable. However, the practice is not required by any religion.

You may have only one chance to save someone’s life!

It’s important to ensure that all patients are reassured that if they’ve been sexually assaulted or abused, it’s not their fault, and that no matter who commits it, or where it happens, FGM is a crime. You can ensure everyone in your practice has an understanding, and this clinical guidance document (Clinical guidance document – Female genital mutilation [PLUS]) outlines healthcare professionals’ responsibilities in relation to FGM. It covers safeguarding, risk assessment, reporting and staff training, whilst providing useful links to training scenarios and further guidance and legislation. It’s an essential policy for every practice. Furthermore, it’s important to have a robust safeguarding policy in place within practice,  this document has been recently updated and covers FGM in more detail, download the latest Safeguarding Policy [PLUS]

Further training is available through Safeguarding training (Levels 1-3)  for both adults and children in the HUB and an in-depth session suitable for your practice, group or PCN can be booked here.

Author – Narinder Sidhu, NS TC Consultancy Services