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Coventry Local Safeguarding Children Board Procedures Manual

Children And Female Genital Mutilation (FGM)

Contents

  1. Definition and Key Facts

  2. Serious Crime Act 2015 and Related Guidance

  3. Professional Response & Processes - Identifying a Child/Young Person Under 18 Years Who has been Subject to FGM

  4. Professional Response & Processes - Identifying a Child/Young Person Under 18 Years Who is at Risk of FGM

  5. Identifying an Under 18's or Over 18 who has Undergone FGM

  6. Professionals Response to Concerns

  7. Protection and Action to be Taken by Local Authority Children's Social Care

    Appendix 1: FGM Prevalence

    Appendix 2: Cultural Underpinnings of FGM

    Appendix 3: Signs that a Girl may be At Risk of FGM or has Undergone FGM?

    Appendix 4: Consequences of FGM on Women and Girls

    Appendix 5: Agencies Offering Help and Advice

    Appendix 6: FGM Safeguarding & Risk Assessment Tool


1. Definition and Key Facts

  • Female genital mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons;
  • The procedure has no health benefits for girls and women;
  • Procedures can cause death, severe bleeding, wound infection and problems urinating, and later cysts, Hepatitis B, HIV and infertility as well as complications in childbirth and increased risk of new born deaths;
  • More than 125 million girls and women alive today have been cut in the 29 countries in Africa and the Middle East where FGM is concentrated;
  • FGM is mostly carried out on young girls sometime between infancy and age 15;
  • FGM is a violation of the human rights of girls and women and is considered as torture under Article 3 of the European Convention on Human Rights.

FGM is recognised internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

Female genital mutilation is classified into four major 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;
  • Type 4: Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

    (World Health Organisation, 2014)

Breast Ironing

Breast ironing, also known as breast flattening, is the pounding and massaging of a pubescent girl's breasts using hard or heated objects, to try to make them stop developing or to disappear. Although not explicitly considered currently under legislation, Practitioners need to be aware of this potential practice and act in the best interest of protecting the child/young person and follow local safeguarding procedures. Breast Ironing is typically carried out by the girl's mother with the belief that she is protecting the girl from sexual harassment and rape, prevent early pregnancy that would tarnish the family name, or to allow the girl to pursue education rather than be forced into early marriage.  It is mostly practiced in parts of Cameroon. Breast ironing is extremely painful and can cause tissue damage. Other possible health impacts include breast infections, the formation of abscesses, malformed breasts or the eradication of one or both breasts. The practice ranges dramatically in its severity, from using heated leaves to press and massage the breasts, to using a scalding grinding stone to crush the budding gland. Due to the range of this activity, health consequences vary from benign to acute.

2. Serious Crime Act 2015 and Related Guidance

A number of legislative changes on FGM were introduced by the Serious Crime Act 2015, which was given royal assent on 3 March 2015.

The act introduces measures to enhance the protection of vulnerable children and others, including strengthening the law to tackle female genital mutilation (FGM) and domestic abuse.

The Act brings in new provisions to tackle FGM by:

  • Extending the extra-territorial reach of the offences in the Female Genital Mutilation Act 2003 so that they apply to habitual as well as permanent UK residents;
  • Introducing a new offence of failing to protect a girl from risk of FGM;
  • Granting lifelong anonymity to victims;
  • Bringing in a civil order (‘FGM protection orders') to protect potential victims;
  • Introducing a duty on regulated professionals in England & Wales, which includes, healthcare professionals, teachers and social care workers, to notify the Police of known cases of FGM carried out on a girl under 18 (Mandatory Reporting of Female Genital Mutilation - procedural information);
  • Introducing a new offence of failing to protect a girl from the risk of genital mutilation. This offence is against:
    1. Those persons with parental responsibility with whom the child has frequent contact; and
    2. Those persons who are aged over 18 years who have assumed responsibility for the child in the manner of a parent (note – this will include foster carers).

In addition there are two international conventions, which contain articles, which can be applied to FGM. Signatory states, including the UK, have an obligation under these standards to take legal action against FGM:

Related Guidance

Mandatory reporting of female genital mutilation: procedural information (Issued October 2015)

Get a female genital mutilation protection order (updated 20 October 2015)

Amendment

Serious Crime Act 2015: Factsheet - Female genital Mutilation

3. Professional Response & Processes - Identifying a Child/Young Person Under 18 Years who has been Subject to FGM

Please use the FGM safeguarding risk assessment tool in Appendix 6, FGM Safeguarding & Risk Assessment Tool. The aim of the risk assessment tool is to have a structured approach to aid an initial assessment of risk, and then support the on-going assessment of individuals who are potentially subject to or at risk of FGM (using parts 1 to 3). Please follow the process map below:

Click here to view the Process Map.

This process map is intended to inform professionals of the processes and procedures that need to be followed when an under 18 year old female is identified as at risk of FGM or has undergone FGM.

4. Professional Response & Processes - Identifying a Child/Young Person Under 18 Years Who is at Risk of FGM

Please use the FGM safeguarding risk assessment tool in Appendix 6, FGM Safeguarding & Risk Assessment Tool. The aim of the risk assessment tool is to have a structured approach to aid an initial assessment of risk, and then support the on-going assessment of individuals who are potentially subject to or at risk of FGM (using parts 1 to 3). Please follow the process map below:

Click here to view the Process Map.

This process map is intended to inform professionals of the processes and procedures that need to be followed when an under 18 year old female is identified as at risk of FGM or has undergone FGM.

5. Identifying an Under 18's or Over 18 who has Undergone FGM

Click here to view the flowchart for Identifying an Under 18's or Over 18 who has Undergone FGM.

6. Professionals Response to Concerns

Summary

Any information or concern that a child is at immediate risk of, or has undergone, female genital mutilation should result in a child protection referral to Children's Social Care in line with the Referrals Procedure of the LSCB Inter-agency procedures.

Where a child is thought to be at risk of FGM practitioners should be alert to the need to act quickly - before the child is abused through the FGM procedure in the UK or taken abroad to undergo the procedure.

Concern that a child is at risk of FGM

Teachers, other school staff, volunteers and members of community groups may become aware that a child is at risk of FGM through a parent/other adult, a child or other children disclosing that:

  • The procedure is being planned;
  • An older child in the family has already undergone FGM.

School nurses in schools are also in a position to identify FGM or receive a disclosure about it at opportunistic drop sessions at schools (see Mandatory Reporting of Female Genital Mutilation - procedural information).

A professional, volunteer or community group member who has information or suspicions that a child is at risk of FGM should consult with their agency or group's Designated Child Protection Adviser (if they have one) and should make an immediate referral to LA Children's Social Care, in line with the Referrals Procedure. The completed FGM Safeguarding Risk Assessment Tool should accompany the referral.

If there is a concern about one child, consideration must be given to whether siblings are at similar risk. Once concerns are raised about FGM there should also be consideration of possible risk to other children in the practicing community.

Concerns that a child has already undergone FGM

Teachers, other school staff, volunteers and members of community groups may become aware that a child has been subjected to FGM through:

A professional, volunteer or community group member who has information or suspicions that a child has been subjected to FGM should consult with their agency or group's Designated Child Protection Adviser (if they have one) and make a referral in line with Section 7, Protection and Action to be Taken by Local Authority Children's Social Care and the Referrals Procedure.

If the child appears to be in acute physical and/or emotional distress, they should make an immediate referral to LA Children's Social Care (in line with Section 7, Protection and Action to be Taken by Local Authority Children's Social Care, using the Referrals Procedure and to the local Health Service).

Health - NHS Actions

Health professionals such as midwives, obstetricians, gynaecologists, general practitioners and paediatricians are most likely to encounter a girl or woman who has been subjected to FGM. They should be aware of the risks to:

  • Any younger sisters;
  • Daughters she has or daughters she may have in the future;
  • Any female members of her extended family.

Since April 2014, all acute Hospital Trusts to record:

  • If a patient has had Female Genital Mutilation;
  • If there is a family history of Female Genital Mutilation;
  • If a Female Genital Mutilation-related procedure has been carried out on a patient;
  • Type of FGM;
  • If the patient has been re-sutured.

Since October 2015 all Hospital Trusts have been required to report this data centrally to the Department of Health on a monthly basis. This is the first stage of a wider ranging programme of work in development to improve the way in which the NHS will respond to the health needs of girls and women who have suffered Female Genital Mutilation and actively support prevention.

Pregnancy and childbirth

Women who have had female genital mutilation should be identified through sensitive enquiry and referred for antenatal examination to the Urogynaecology Consultant in line with Antenatal guidance.  Health Practitioners, including Midwives and Health Visitors should consider commencing a CAF (Common Assessment Framework) as part of the early help offer.

Midwifery Services

If FGM is identified in the ante natal or post natal period the midwife should complete the FGM assessment tool. If a positive response is gained, referral to social care/Police as appropriate. If the patient is clear she does not support FGM activity the conversation must be clearly recorded in relevant documentation.

Maternity services should inform health visitor colleagues of any FGM cases

Counselling regarding re-infibulation

All girls/women who have undergone FGM, as well as their partners or husbands; and in the case of girls under 18, her parents, should be informed that re-infibulation is illegal and will not be done under any circumstances.

Counselling sessions should be offered and arranged, taking into account that the woman may not want to make the arrangements about it when her partner or husband or other family members are present. Consideration should be given to offering counselling to partners and husbands.

Mandatory Reporting of FGM

From 31st October 2015, Regulated health, social care professionals and teachers must report cases of FGM to the Police via 101 or in writing if:

  • A girl under 18 tells them they've had FGM;
  • They see physical signs that a girl has had FGM.

This applies to all registered professionals in NHS, Primary Care and Private Healthcare settings.

A failure to report the discovery in the course of their work could result in a referral to their professional body and a criminal charge being brought against them.

For further information, see Information Standards Board for Health and Social Care Female Genital Mutilation Prevalence Dataset Standard Specification.

See Fact sheet on mandatory reporting of female genital mutilation (GOV.UK).

7. Protection and Action to be Taken by Local Authority Children's Social Care

If there are suspicions that a girl under the age of 18 years may have undergone FGM or is at risk of FGM professionals must still report the issue by following their internal safeguarding procedures.

Where concerns about the welfare and safety of a child or young woman have come to light in relation to FGM, a referral to Children's Social Care should be made in accordance with the Referral Procedure.

Children's Social Care will investigate (initially) via the completion of a Children & Families Assessment under Section 17 of the Children Act 1989. If it is considered that the threat of FGM is imminent then urgent legal advice must be sought and a Strategy Meeting must be convened as a matter of urgency to consider section 47 enquiries being undertaken.

If a referral is received concerning one child, consideration must be given as to whether female siblings are at similar risk.

Once concerns are raised about FGM there should also be consideration of possible risk to other female children in the practicing community. Professionals should be alert to the fact that any one of the female children amongst these could be identified as being at risk of FGM and will then need to be responded to as a child in need or a child in need of protection.

Section 47 Enquiries – Strategy Meeting

As a result of the Children & Families Assessment (Section 17 of the Children Act 1989), a Strategy Meeting may be convened. It should be convened within two working days (but in some cases, depending upon the outcome of the Children & Families (C&F) assessment, the meeting may need to take place immediately), and should involve representatives from Police, Children's Social Care, Education, Health and any voluntary services that could provide specialist information and advice regarding FGM. Health providers or voluntary organisations with specific expertise must be invited; and consideration may also be given to inviting a legal advisor.

In addition to the issues considered at all Strategy Meetings, the meeting should also establish:

  • How best to approach the family and seek their co-operation;
  • Whether the child's parents are well informed about the harmful aspects of FGM and the law in the UK;
  • If the parents are not well informed, how could they best be provided with appropriate information;
  • Whether a medical examination is required and if so, for what purpose;
  • What action may be necessary in response to any attempt to remove the child from the UK.

An interpreter appropriately trained in all aspects of FGM should be used in all interviews with the family. A female interpreter should be used where possible and must not be a family relation.

Every attempt should be made to work with parents on a voluntary basis to prevent the abuse. It is the duty of the investigating team to look at every possible way that parental co-operation can be achieved, including the use of community organisations and/or community leaders to facilitate the work with parents/family. However, the child's (and other children's) wellbeing and safety is paramount at all times and therefore careful consideration must be given not to inform the wider community of this should increase the risks to the child(ren)

If no agreement with the parents is reached, the first priority is the protection of the child and the least intrusive legal action should be taken to ensure the child's safety.

No evidence of risk

If the Children and Family assessment and the Strategy Meeting concludes that there is no clear evidence of risk to a child, Children's Social Care will:

  • Consult with the child's GP about this conclusion and invite him/her to notify social care immediately if any further concerns are raised about the risk of FGM;
  • Notify appropriate professionals involved with the family of the outcome of the enquiries made;
  • Inform the family and the referrer that the enquiry has been concluded; and
  • Offer the family any appropriate support services.

Child at risk of genital mutilation

If, the outcome of the Children and Family Assessment or the Section 47 enquiries identifies that a child is at risk of female genital mutilation, the social worker must:

  • Seek immediate legal advice to consider which Orders may be the most appropriate to safeguard the child.  If there is an imminent risk of harm then consideration needs to be given as to whether there is a need to seek an Emergency Protection Order to safeguard the child or in the alternative whether a FGM Protection Order should be sought to prevent the child being removed from the UK;
  • Notify the parents that FGM is a criminal act in England & Wales and ensure that the parents are provided with comprehensive information about the law surrounding Female Genital Mutilation;
  • Give consideration to a convene a child protection conference to determine whether threshold is met for a CP plan.

If a child protection conference concludes that the child needs to be subject to a child protection plan, female genital mutilation is normally regarded as a form of physical, rather than sexual abuse.

If the child has already undergone genital mutilation

If the family's primary language is not English, a female interpreter where possible, must assist at any interview with them and ideally the interpreter should be appropriately trained in relation to FGM.  The interpreter must not be a family member.

In this situation any action taken should focus on:

  • Any available information about how, when and where the procedure was performed;
  • Obtaining any additional information which may assist the Police in their enquiries in respect of any possible criminal prosecution;
  • How to address any concerns for the welfare of the child who has undergone the procedure, including, but not limited to, any health implications;
  • The implications for any other children in the family, including the extended family;
  • The family's need for support services;
  • The family's willingness to co-operate with the agencies concerned; gaining written agreement from the family that they will not let any additional female children undergo the procedure;
  • Health education and other work with the family to reduce the risk to other members of the family;
  • Support the family may need in the face of community pressure;
  • Community reaction to the child and family;
  • If there are any other safeguarding concerns about the care of the child whether a child protection conference should be convened. At the Strategy Meeting consideration needs to be given to the risks to any other female children in the family.

Second Strategy Meetings should be the exception and should therefore not be seen as part of a normal process. However, if deemed necessary, the second Strategy Meeting should take place within ten working days of the referral, with the same chair. This meeting must evaluate the information collected in the enquiry and recommend whether a child protection conference is necessary, in line with the Child Protection Conferences Procedure.

If it appears that no other children are at risk:

Children's Social Care Services will take no further action other than to consider any of the physical and emotional concerns for the child who has undergone the procedure; In the event any additional needs are identified consideration should be given to either continued support to meet those needs by the relevant early help agency with the Common Assessment Framework (step down to CAF arena) or signposting to universal services.

Children's Social Care will notify the child's GP and midwifery services to invite them to notify them if any changes in the situation give rise to further concerns, e.g. the mother giving birth to further girls.

The Police

After a report has been made to the Police by any regulated professional; the Police will consult with Children's Social Care and a decision will then be made whether any Police action is necessary to ensure the child is safeguarded. 

FGM is considered a serious crime and the Child Abuse Investigation Unit (CAIU) will take a lead role in any investigation necessary.  The Police recognises the need for an effective investigative response to what is regarded as an extremely severe form of child abuse, recognising the immediate and long term pain, suffering and risks to health associated with this practice.

Appendix 1: FGM Prevalence

Click here to view Appendix 1: FGM Prevalence which details the percentage of girls and women aged 15-49 who have undergone FGM by country and the percentage distribution of ages at which girls have undergone FGM (as reported by their mothers) (UNICEF 2013).

Appendix 2: Cultural Underpinnings of FGM

Parents who support the practice of female genital mutilation say that they are acting in the child's best interests. The reasons they give include that it:

  • Brings status and respect to the girl;
  • Preserves a girl's virginity/chastity;
  • Is part of being a woman;
  • Is a rite of passage;
  • Gives a girl social acceptance especially for marriage;
  • Upholds the family honour;
  • Gives the girl and her family a sense of belonging to the community;
  • Fulfils a religious requirement mistakenly believed to exist;
  • Perpetuates a custom/tradition;
  • Helps girls and women to be clean and hygienic;
  • Is cosmetically desirable; and
  • Is mistakenly believed to make childbirth safer for the infant.

It is because of these beliefs that girls and women who have not undergone FGM are often considered by practising communities to be unsuitable for marriage. Women who have attempted to resist exposing their daughters to FGM report that they and their families were ostracised by their community and told that nobody would want to marry their daughters.

Appendix 3: Signs that a Girl may be At Risk of FGM or has Undergone FGM?

Suspicions may arise in a number of ways that a child is being prepared for FGM to take place abroad. These include;

  • Knowing that the family belongs to a community in which FGM is practised;
  • Knowing the family is making preparations for the child to take a holiday, arranging vaccinations or planning absence from school;
  • The child may talk about a special procedure/ceremony that is going to take place or becoming a woman.

Indicators that FGM may already have occurred include:

  • Prolonged absence from school or other activities;
  • Noticeable behaviour change on return from absence;
  • Bladder or menstrual problems;
  • Difficulty sitting still;
  • Looking uncomfortable;
  • Complain about pain between their legs;
  • Talk of something somebody did to them that they are not allowed to talk about.

Appendix 4: Consequences of FGM on Women and Girls

Click here to view Appendix 4: Consequences of FGM on Women and Girls, a chart on how genital cutting affects girls and woman throughout their lives.

Appendix 5: Agencies Offering Help and Advice

Petals – the UK's first FGM web app.

Petals is an app which signposts and gives advice for girls and women on how to get support to deal with FGM. The app gives advice on how to get support and deal with FGM. It can also be used by people who want to find out more about Female Genital Mutilation and how it might affect them and others they may know. The app is available to download now.

Help and support

If you, or a child you know is in immediate danger, you should contact the Police on 0345 113 5000 or call 999 in an emergency.

If there is no immediate danger or you need advice or information, you should call the Coventry Safeguarding Referral and Assessment Service on 024 76 78 8555 or the Police on 101.

Non-urgent advice for British nationals abroad can be obtained from the Foreign & Commonwealth Office Helpline on 020 708 1500.

Other organisations that can help:

NSPCC FGM helpline:
Tel: 0800 028 3550 (free, anonymous and 24/7) or
Email: fgmhelp@nspcc.or.uk.

Childline
Tel: 0800 1111 (24 hour helpline for children)
Website: www.childline.org.uk

Coventry Children's Social Care referral and Assessment Service (RAS)
Tel: 024 7678 8555

Coventry Child Abuse Investigation Team
Tel: 024 7653 9044

Contact the Police: 101 (non urgent calls) or 999 (emergency calls)

Birmingham & Solihull Women's Aid, Birmingham
Tel: 0808 800 0028 (Freephone)

Coventry Rape and Sexual Abuse Centre (CRASAC)
Tel: 02476 277777,
Email: info@crasac.org.uk
Website: www.crasac.org.uk

Coventry Haven
Tel: 02476 444077,
Email: coventryhaven@btconnect.com
Website: www.coventryhaven.co.uk

Celestinecelest Community Organisation
Tel: 07517 227 911
Email: vkamara@celstinecelest.org

There are over 14 specialist clinics across the UK which are supporting women who have undergone FGM. Click here for a full list.

Female Genital Mutilation Protection Order (FGMPO)

An application can be made to the Court for a FGM Protection Order. The application can be made by the girl who is to be protected or by a relevant third party (such as a Local Authority). If a person is known to be at significant risk of FGM then an application for a FGM Protection Order can be made on a without notice basis. There is no fee payable to the Court.

Download and fill in an application form (FGM001). Birmingham Family Court and Civil Justice Centre is the nearest Court to Coventry where these applications can be heard.

Appendix 6: FGM Safeguarding & Risk Assessment Tool

Click here to view Appendix 6: FGM Safeguarding & Risk Assessment Tool.