Home Affairs Committee: Written evidence
Female Genital Mutilation
This volume contains the written evidence accepted by the Home Affairs Committee for the Female Genital Mutilation inquiry.
FGM0001 Children and Families Across Borders (CFAB) 1 02 Anonymous unpublished submission FGM0003 Buckinghamshire County Council 5 FGM0004 NSPCC 9 FGM0005 Genital Autonomy 15 06 Duplicate submission 07 Duplicate submission FGM0008 Bar Human Rights Committee of England and Wales (BHRC) 18 FGM0009 Local Government Association 30 FGM0010 28 Too Many 31 FGM0011 International Association of Women Police 37 FGM0012 Professor Lisa Avalos 44 FGM0013 British Medical Association 56 FGM0014 UCL Graduate Law Society 57 FGM0015 Movement for Justice 63 FGM0016 PCC for Northumbria 67 FGM0017 Hawa Trust 70 FGM0018 ACCM (UK) 79 FGM0019 Avon and Somerset Constabulary and PCC 85 FGM0020 London Borough of Havering 90 FGM0021 Ralph Tilby 92 FGM0022 Intercollegiate Group on FGM 94 FGM0023 Juliet Albert 101 FGM0024 The Victoria Climbié Foundation UK 103 FGM0025 Metropolitan Police 106 FGM0026 Tackling FGM Initiative 117 FGM0027 Hilary Burrage 125 FGM0028 Rights of Women and Asylum Aid 133 FGM0029 Government 141 FGM0030 Bawso 150 FGM0031 Muslim Women's Network UK 155 32 Duplicate submission FGM0033 Fahma Mohamed 161 34 Duplicate submission FGM0035 FPA and Brook 165 FGM0036 NAHT 171 FGM0037 London Borough of Newham 173 FGM0038 Professor Sarah Creighton 180 FGM0039 Guardian News & Media 182 FGM0040 Tony Lloyd, Greater Manchester PCC 184 FGM0041 Dr Comfort Momoh MBE 188 FGM0042 Lancashire Constabulary 190 FGM0043 Dr Deborah T Hodes 193 44 Duplicate submission FGM0045 Mayor of London’s Harmful Practices Taskforce 195 FGM0046 Association of Chief Police Officers (ACPO) 201 FGM0047 Foundation for Women’s Health Research and Development (FORWARD UK) 213 FGM0048 Equality and Human Rights Commission 227 FGM0049 Alison Macfarlane and Efua Dorkenoo 237 FGM0050 Crown Prosecution Service 240 FGM0051 Yana Richens OBE 247 FGM0052 Royal College of General Practitioners 249 FGM0053 Graham Senior-Milne 254 FGM0054 Peer Exchange 260 FGM0055 Liberal Democrats for Seekers of Sanctuary 264 FGM0056 NSPCC supplementary 265 FGM0057 London Safeguarding Children Board 266
As at 13 May 2014
Written evidence submitted by Children and Families Across Borders (CFAB)
How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
1. CFAB’s strong suspicion is that the present legislation will not lead to a prosecution as it relies on victim testimony. As this will involve children giving evidence against close family members, often their parents, it is unlikely this will happen. However, as very few cases have been passed to CPS more cases may be needed to evidence this viewpoint. CFAB’s view is that a law which states simply that it is an offence to allow your child to have undergone FGM would be more effective.
2. The main barrier to a prosecution is that the child protection system in the UK is not set up to deal with an issue such as FGM. The child protection system is reactive and depends on referrals being made to social services. To prevent and investigate FGM social workers must be proactive and seek out potential victims as victims will not disclose and referrals will not be made as the abuse remains hidden until the children are adults and have children themselves. Also most of the abuse occurs overseas.
3. To work proactively, midwifery services and social workers must work together using the starting cohort of all mothers who have been victims of FGM who have daughters. Using risk assessment tools and meeting with families, social workers and midwives can undertake preventative work and also assess which children are most at risk.
4. Those families most at risk will be very clearly informed as to the law and monitored. In the unlikely event a parent states explicitly they will put their child through FGM, care proceedings can be issued. A more likely outcome is the family being seen as a risk and a strategy meeting involving health, police, school and social services will be arranged. From this meeting, each agency will be aware to be vigilant (especially either side of the summer holiday as that is when most abuse occurs) and the family can be flagged with Border Force and the police/local authority informed if the child returns from overseas (we have no exit checks so cannot flag people on the way out) Police and Social Workers can then work together to discover where they have been. If it is to a high prevalence country, the family can be visited under s.47 of the 1989 Children Act and, if this leads Police and Social Workers to believe FGM has occurred a child protection medical can be ordered (if the parents refuse consent this can be given by the family courts). The medical will give the definitive evidence. If
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the law is changed (as suggested in point 1 above) prosecutions could then proceed without victim testimony.
Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
5. As stated above, the biggest indicator that a child is at risk of FGM is that her Mother is a victim of FGM. If the Mother gave birth in the UK then the Midwifery services know that the Mother was a victim and this should be recorded on their medical notes.
6. At present the fact that the Mother has been a victim is not shared with Police or social services. Even the fact that she is a victim and has a daughter will not meet the threshold for social services or Police intervention. The project approach described in points 3 and 4 above is required
What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi‐agency co‐operation be improved?
7. As described in points 3 and 4 above the key professionals are Health, Social Workers and Police. Schools have a role in alerting social workers if the child talks of plans for a summer trip to a high incidence country and looking for changes in the child’s presentation after the summer holiday but it is extremely unlikely that the child will disclose.
8. Voluntary agencies such as CFAB can assist in training social workers and related safeguarding professionals in identifying and investigating FGM.
9. Health services have a further key role in getting out clear health messages to women from high prevalence groups about the very real, profound and long term adverse effects of FGM on sexual, reproductive and mental health.
10. Other voluntary agencies such as Daughters of Eve, Imkaan and Forward have a key role to play in engaging at‐risk communities and seeking to change attitudes to FGM so it becomes culturally unacceptable. Long term, this is the key piece of work but it will be hugely assisted by a small number of high profile
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prosecutions and a large number of child protection investigations so prospective perpetrators know that enforcement action can and is being taken. At present, perpetrators know that the authorities are not enforcing the law.
11. Significant resource has been put into the NSPCC FGM helpline. However given that victims are very unlikely to disclose and other family members are equally unlikely to disclose this has not been, perhaps, the wisest use of scant resource. As explained in point 2 above, this form of child abuse is not going to be referred to statutory agencies, they have to proactively look for it.
How can the systems for collecting and sharing information on FGM be improved?
12. Child protection systems generally work well in the UK. The issue is that victims and potential victims of FGM are outside of these procedures. If the approach described in points 3 and 4 above is adopted then this will change. For this to work the key data to collect and share is Mothers who are victims of FGM who have daughters.
13. Once potential victims are in the child protection system the social worker will lead the multi professional team and information sharing will be a key part of this..
How effective are existing efforts to raise awareness of FGM?
14. There have been more media articles about FGM than child protection investigations into FGM. Therefore wider public awareness has been achieved. However, targeted awareness‐raising of the law and the health risks to victims of FGM needs to be given far greater emphasis and resource. This can be done through maternity services, health visiting and school nursing services and utilising the reach of the voluntary agencies mentioned in point 10 above.
How can the available support and services be improved for women and girls in the UK who have suffered FGM?
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15. This is not an area of expertise for CFAB but victim care, both for physical and emotional and mental health is key; as it is in all forms of child abuse. Therefore clinics specialising in reconstruction as well as support, counselling and self help groups should be widely available in areas with communities more likely to be victims.
Children and Families Across Borders (CFAB) January 2014
4 Written evidence submitted by Buckinghamshire County Council
Commons Select Committee- Female Genital Mutilation
Written evidence submitted by Faye Blunstone, Community Safety coordinator at Bucks County Council
Executive Summary:
In this report there are insights from two professionals (originating from the Family Resilience Service and the Children and Family Service in Buckinghamshire) and the following views have been taken:
• The current legislation around FGM is ineffective and unclear. • Ethnic minority groups in the UK are perceived as being at greater risk of FGM. This may be due to conceived cultural beliefs within communities that are not meant to be challenged but upheld by both perpetrator and victim. • The barriers to intervention are similar to domestic violence, the victim’s acceptance of the ritual or alternatively fearful of reporting FGM. Also perpetrators may be family to the victim so this may be perceived by the victim as normalised behaviour. • Preventing FGM will be possible when education and awareness raising are made a vital part of young girl’s lives in school as well as challenging the views of the communities that reside among us that have a belief in the longevity of FGM. • FGM legislation needs to state that ALL forms of non-medical genital surgery on girls under 18 are illegal. • The sphere of Education is an essential body for positively educating young girls, to help those who are at risk or encourage those who have already become victim to come forward. Health professionals need to be trained to recognise FGM. • The ideology that genital examinations on girls believed to have become victim of FGM as abusive needs to be counteracted so as to detect FGM and prevent future cases. This needs to incorporate many types of services that come into contact with potential at risk victims but most importantly embody the medical profession as well as children and adult social care services. • There is no clear framework for collecting and sharing information on FGM. • In terms of raising awareness on FGM, some DV lead workers in our area were unsure of the questions posed so therefore awareness raising criteria is not robust enough. However, if there were raised incidents these workers would expect the cases to be brought up to the Multi Agency Risk Assessment Conference (MARAC). Many agencies are however, vehemently working within the communities affected to reject the acceptance of FGM. • Professionals who come into contact with women and girls who have been affected need to know about it, to recognise the signs and understand the risks and have clear policies and procedures on how to respond. • The legislation needs to be more transparent and with it the communication of the law transferred to professionals in an understandable and clear cut method.
Introduction:
5 I submit this submission on behalf of Buckinghamshire County Council Safer Communities department and its partners. Colleagues in domestic violence, safeguarding and community safety have been approached for their insight and perspective into the abhorrent crime which is Female Genital Mutilation (FGM). We are submitting evidence due to the fact that there has not been a successful conviction of a perpetrator for 28 years, this being since the legislation against it had been first passed. In Buckinghamshire there are four districts: Aylesbury Vale, Chiltern and South Bucks and High Wycombe. Generally Buckinghamshire is an affluent county although there are some economically deprived pockets of the community. There is a diverse mix of cultures and communities and a population of 26,300 people. It is in the best interests of our residents that we have a clear stance on FGM and be at the forefront to know of any progressions in legislation and education so that this can be disseminated to professionals within the field who may come into contact with young people who are susceptible.
1. How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
1.1 Commenting on the existing legislative framework around FGM is difficult as we do not know in its entirety what it is. What is known is that the FGM legislative framework is perceived as ineffective as there have been no prosecutions at this point. Framing FGM as a women's rights issue enables FGM to be discussed alongside other abuses against women and girls. The UK has to hold up a mirror to its society as a whole, not just single out specific abuses practiced by 'other' communities. FGM is a severe manifestation of violence against women and girls, but it is not the only one.
2. Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
2.1 The groups most at risk would be ethnic minority groups and specifically those who may originate from the following countries: Somalia, Uganda, Tanzania, Kenya, Nigeria, Ghana, Sierra Leone, Egypt, Ethiopia and Sudan. However, identifying 'at risk' or 'affected communities' must go further than naming countries as residing within the UK. There are communities that are affected by FGM and others that are not.
2.2 A barrier in identification and intervention is, as with all DV related issues, the fact that victims largely do not report the incidents. This is increased in ethnic minority groups due to the nature of their cultural beliefs. Secondly a further barrier is that FGM is predominantly carried out on young girls by, or under instruction, of members of her family. Expecting young girls to report on their loved ones, when FGM is presented to them as an important part of their lives and essential in being accepted in their community, is unrealistic without effective education and awareness raising.
It is essential that legislation goes hand in hand with community interventions, education and awareness raising. The legislation needs to state that ALL forms of non-medical genital surgery on girls under 18 are illegal. This includes FGM and all types of Female Genital Surgery on girls whether it is seen as cultural or cosmetic. It is then clear that this is illegal for everyone, not just targeting specific communities.
6 In terms of groups at risk, the FGM Act 2003 is badly worded insofar that girl includes woman, which renders the agency of women from affected communities to that of a child. This could be regarded by girls and women as a misrepresentation.
3. What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
3.1 Health professionals need to be trained to recognise FGM using the WHO typology, FGM is not a uniform practice, and there are different types of FGM that vary in severity. The attitude that appropriate genital examinations on children identified as susceptible is necessary to identifying cases which have taken place. Failure to prevent or identify potential cases put children at risk.
3.2 Education professionals need to be allowed to talk about the issue. For FGM to be successfully tackled in schools and communities we need to stop referring to it simply as a cultural practice, it needs to be understood as a harmful practice that is an abuse against women and girls.
4. How can the systems for collecting and sharing information on FGM be improved?
4.1 Currently there are no clear systems so this needs to be set up.
5. How effective are existing efforts to raise awareness of FGM?
5.1 The fact that some specialist domestic violence lead workers in Buckinghamshire were not exactly sure about the questions on this subject may indicate that the current efforts to raise awareness are not robust enough. If there were any reported incidents of FGM we would expect them to be taken to the Multi Agency Risk Assessment Conference (MARAC). It must be noted there are efforts from a lot of organisations who work very hard to support communities affected by FGM in rejecting the practice.
6. How can the available support and services be improved for women and girls in the UK who have suffered FGM?
6.1 Professionals who come into contact with women and girls who have been affected need to know about it, to recognise the signs and understand the risks. The legislation around re- infibulation needs to be clear, and be communicated to professionals coming into contact with child bearing women from affected communities.
Recommendations:
• Legislation needs to be made clearer and tied in with community interventions, effective education and awareness raising. • Legislation needs to state that all types of non-medical FGM on girls/women (under 18) are illegal, whether cosmetic or cultural.
7 • Health professionals need to be trained to recognise FGM using the WHO typology. • Appropriate genital examinations on at risk children to be carried out and a stop to the perceived ideology of it being abusive. • Revision of the definition of FGM as the current definition is badly worded insofar that girl includes woman which classifies women in the same remit as a child. • Our society as a whole needs to be addressed regarding FGM, confining/labelling its whereabouts in a singular or small cluster of communities will not fully stop or prevent FGM.
Buckinghamshire County Council
Feb 2014
8 Written evidence submitted by the NSPCC
Executive Summary 1. The NSPCC welcomes the Home Affairs Select Committee’s focus on Female Genital Mutilation (FGM) and agree it is unacceptable that there has not been a single successful prosecution in the UK. However, while we must consider the reasons for such lack of prosecutions, we believe the main focus should be on prevention and intervention with each individual child that is subjected to, or at risk of, this abuse.
2. The legislative framework is clear that FGM is a criminal activity, and there should be no doubt in labelling it as abuse. This illegal and life-threatening initiation ritual can leave young victims in agony and with physical and psychological problems that can continue into adulthood.
3. Our response to the specific questions posed by the Committee is based on our expertise as a national charity that works to prevent cruelty to children in the UK. In June 2013 the NSPCC launched a dedicated 24-hour Helpline to protect UK children from FGM. ChildLine has also received a small number of calls from children who have suffered or are at risk of FGM. Where possible, our response draws on the information gathered from these helplines. This is baseline data that we are still developing and we would be happy to share further information with the Committee at a later date. We would also like to invite members of the Committee to visit the FGM helpline to speak with counsellors in order to gain a greater insight into the nature of calls we receive and what we are learning from this.
4. While the NSPCC supports the existing legislative framework we have concerns that it creates many requirements before an offence is committed and we believe that consideration should be given to how ‘preparatory’ offences could contribute to the preventative legislative framework. We also believe that the main barriers to achieving a successful prosecution in the UK are the social norms that FGM operates within. The strategy to eradicate FGM should include a commitment by child protection agencies to engage with communities to improve understanding of why FGM is abuse, and support communities in measures for a collective call to identify and eradicate the practice.
5. In order to improve identification and intervention, there must be an increased awareness of the issue among professionals, and they must have a greater understanding of their role and responsibilities in identifying and protecting vulnerable groups of children in the communities they serve.
6. Support and services for women and girls in the UK who have suffered FGM should be underpinned by a focus on the individual child and their recovery. Given the nature and complexity of FGM, specialist culturally sensitive support services must be developed alongside mainstream ones, to offer girls therapeutic and other forms of support to help them overcome their ordeals.
Introduction 7. The National Society for the Prevention of Cruelty to Children (NSPCC) is the UK's leading charity specialising in child protection and the prevention of cruelty to children. In pursuit of our vision we: • Create and deliver services for children which are innovative and demonstrate how to enhance child protection most effectively; • Provide advice and support to ensure that every child is listened to and protected through ChildLine;
9 • Provide advice and support to adults and professionals concerned about a child and if necessary take action to protect the child through our 24 hour adult helpline (alongside bespoke helplines such as our FGM helpline); • Campaign for changes to legislation, policy and practice to ensure they best protect children; • Inform and educate the public to change attitudes and behaviours towards children;
8. NSPCC’s dedicated FGM helpline Since the launch of the FGM Helpline in June 2013 we have captured provisional data on FGM. Our free 24-hour Helpline is for anyone concerned that a child’s welfare is at risk because of FGM and is seeking advice, information or support. Though callers’ details can remain anonymous, any information that could protect a child from abuse is passed to the police or social services. To date, there have been 152 calls/emails to the Helpline: • 31 were professionals seeking general advice about FGM. • 56 were enquiries about more detailed information/training. • 65 were referrals by professionals concerned about specific young people. Referrals were forwarded to police and children services.
9. FGM data from ChildLine Further provisional information is available from ChildLine: • From 1st April 2013 to 31st December 2013, ChildLine has dealt with 20 counselling sessions about FGM. Of these, 17 were with a child or young person who was contacting about a personal concern, and 3 were from a young person who had concerns about another child or young person being at risk of FGM, most commonly a sister or other female relative. • Three quarters of young people counselled about FGM were aged 12-15 (76%) and just under a quarter were aged 16-18 (24%). The most counselled age was 14 years old.
How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
10. It is important to consider the effectiveness of existing legislative framework on FGM in the UK but the NSPCC believes the main barriers to achieving a successful prosecution in the UK are the social norms that FGM operates within.
11. The legislative framework in the UK makes it clear that FGM is a criminal act. Under the Female Genital Mutilation Act 2003, FGM is illegal in England, Wales, and Northern Ireland, whilst the Prohibition of Female Genital Mutilation Act 2005 prohibits it in Scotland. The legislative framework is also clear in establishing that in certain circumstances it is a criminal offence to carry out FGM abroad, and to aid, abet, counsel or procure the carrying out of FGM abroad, including where the practice is legal.
12. The NSPCC supports these Acts, although we have concerns that they create many requirements before an offence is committed and we believe that consideration should be given to how ‘preparatory’ offences could contribute to the preventative legislative framework. We are aware through discussions with CPS and police that prosecuting offences of FGM is difficult because of the combination of acts and intentions required to prove an offence. In 1993 and 2000 the General Medical Council struck off two doctors for acts relating to FGM: one for performing FGM and the other for agreeing to carry out the procedure. Though both doctors were struck off, the police refused to prosecute.1 More work may be necessary to define new offences targeting the preparatory phases of
1 British Medical Association (2011) ‘Female Genital Mutilation: Caring for patients and safeguarding children’, p. 6
10 FGM, for example an offence of agreeing to carry out FGM and commissioning a person to do so.
13. The main barrier to achieving a successful prosecution in the UK, however, is that in some cultures FGM is considered a social norm, meaning it is difficult for individual families to stop the practice on their own. Until these social norms are challenged, it will be difficult for members of communities to come forward to share their concerns about children vulnerable to FGM. There can be a social obligation within families or communities to conform to the practice and a widespread belief that if they do not, they are likely to pay a price that could include social exclusion, criticism, ridicule, stigma or the inability to find their daughters suitable marriage partners. Conversely, families will be encouraged not to cut their daughters if they are convinced that a sufficiently large number of other families do not practise FGM or are ready to abandon the practice. We believe that there may be potential to harness these positive community examples for the broader preventative effort.
14. Therefore, improving understanding of these social norms should also be part of the strategy for the eradication of FGM. Such a strategy should include a commitment by child protection agencies to engage with communities to improve understanding of why FGM is abuse, and support for communities in measures to identify and eradicate the practice.
What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
15. Ultimately all agencies should be responsible for early identification and support for individual children whether at risk of FGM or victims of the practice.
16. Two recent NSPCC surveys that examined professionals’ knowledge and understanding of FGM found many lack awareness, confidence, and competence to address concerns around FGM. A 2013 YouGov poll2 of 1000 teachers found that: • Four out of five of the 1,000 teachers, surveyed said they had not had FGM child protection training about girls at risk. • One in six teachers said they did not know that FGM was illegal in the UK, and that there was a legal duty on them to take action to safeguard children at risk. • Seven out of ten teachers said they were not aware that there was Government guidance on how they should be dealing with FGM at their school. • One teacher who was questioned for the survey said: “This issue is something that I have neither heard of, or had training around. I feel uncomfortable that I do not know enough about this to help protect the children I teach”. Another said: “My concerns were dismissed as 'unlikely' by the school's head of child protection”.
17. A second survey by the Wales FGM Forum3 of 400 professionals found that: • More than 90% of respondents said they were aware of FGM. • More than half of those with knowledge of FGM (52%) were unsure exactly who was at risk. • More than two thirds of professionals called for better information and training on the issue of FGM. • Worryingly 44% of respondents had no knowledge of any statutory guidance on FGM. 45% of respondents were aware of the All Wales Child Protection Procedures protocol on FGM and 32% knew of the UK Government guidelines on FGM.
2 YouGov plc for NSPCC (2013) Sample size: 1002 teachers in England and Wales. 3 NSPCC Cymru for Wales FGM Forum (2014)
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NSPCC FGM Helpline case studies
A GP called who was concerned that a 5-year-old female may be at risk of FGM because he is aware that the child’s mother and sister have all undergone FGM in Somalia.
The GP had not yet visited the family and wanted to know how he should prepare for the visit. Our Helpline practitioner advised the GP how he could discuss the issues of FGM
with the family and the risks associated for the child alongside the legal framework in the UK. Our practitioner also gave advice regarding available leaflets/materials written in Somali and English to help approach the subject matter alongside signposting local community groups in the area specialising in FGM.
The Helpline practitioner was clear with the GP that based upon the information already provided the child might be at high risk of FGM and that a referral to Children Services could help. The GP stated that he would speak to Children's Services following his visit and call back.
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A teacher called who was worried about a 10-year-old Egyptian girl in her class. She did not come to school one day and when she asked her friend where she was she was told she was sick. This was challenged by the teacher and the friend stated that in fact she was going to Egypt with family but she had been asked not to tell.
The Helpline practitioner asked the teacher whether the girls’ secretive behaviour was unusual , and the teacher stated it was. The teacher did not know any time in the last couple of years that the girl had gone to Egypt and her attendance at school was usually
very good. The school was unaware of there being any holiday plans and the school had tried that morning to ring the girl’s mother but no one was answering.
The Helpline practitioner talked through the risk factors of the case with the teacher and was clear that immediate referrals were required to Police and Children Services. On request of the school, the Helpline Practitioner contacted Children Services, the local police and the Metropolitan Police specialising in FGM.
18. As the evidence above suggests, there must be an increased awareness of the issue among professionals who could come into contact with victims or those at risk of FGM in order to improve identification and intervention. Government should work with relevant agencies and organisations to ensure professionals are aware of the signs of FGM, and of their responsibility to flag concerns, as they would with any other form of child abuse. The case studies also demonstrate a clear need for greater training and information provision.
19. The lack of understanding and awareness of FGM amongst frontline practitioners particularly within health, social services and education may be compounded by a reluctance to intervene due to cultural sensitivity and agencies concerned about being seen as racist. This means that professionals are missing opportunities to identify girls at risk and prevent harmful practices. Practitioners, particularly in universal services, need to be supported via the development of a framework of cultural engagement to enable them to understand how cultural norms can, within some groups, facilitate FGM.
20. Multi-agency co-operation must be improved by each Local Safeguarding Children’s Board developing measures or standards that enable progress to be monitored on the prevention
12 and protection of vulnerable children from FGM. Government should also consider how to raise FGM as a key focus for Multi-Agency Safeguarding Hubs.
How can the systems for collecting and sharing information on FGM be improved?
21. The system for collecting and sharing information on FGM would be best improved by establishing a multi-agency response working group for tackling FGM in the UK. Such a group would ideally meet regularly to develop and check progress on measures to prevent and protect vulnerable children from FGM.
22. This would help the collection of information and ensure it is shared systematically. Information sharing protocols should exist between health, police, children services, and other agencies to improve the protection of vulnerable girls and women. Additionally, a robust data system should be developed for surveillance, auditing and monitoring of FGM by statutory agencies. Hence we welcome the recent announcement that health professionals in Britain will be required to register cases of FGM as part of efforts to combat the practice. We understand that from April it will be mandatory for all National Health Service (NHS) hospitals to log cases of FGM in a central database to help provide an idea of the scale of the problem in UK. Measures like these would both empower frontline professionals, and also provide increased accountability. Ultimately this would help professionals identify girls at risk and refer them as part of their child safeguarding obligation, and also improve the reporting of cases of FGM. We believe these measures would consequently empower more girls and young women to come forward if they were at risk of, or had undergone, FGM.
How can the available support and services be improved for women and girls in the UK who have suffered FGM?
23. Support and services for women and girls in the UK who have suffered FGM should be underpinned by a focus on the individual child and their recovery. The calls ChildLine have received on FGM show that, despite many young girls contacting ChildLine about FGM in their teens, most told the counsellor that the procedure had taken place years before, when they were much younger. Often the young person spoke about feeling isolated and unable to speak to anyone about what they had experienced for fear of judgement. Many said that the ChildLine counsellor was the first person they had been able to talk to, stating how difficult it was for them to vocalise what had happened. Many expressed how deeply traumatised they were about what had happened and were audibly emotional during their counselling session with a ChildLine counsellor.
24. It is important given the nature and complexity of FGM that, along with research, specialist culturally sensitive support services are developed alongside mainstream ones, to offer girls therapeutic and other forms of support to help them overcome their ordeals. These girls could also be isolated and ostracised by their families and wider communities and helping them to develop new relationships and networks is crucial. Any new models of intervention developed by these specialist services should be evaluated and, if successful, rolled out to other agencies over time.
25. Further research is also necessary on the impact of FGM on the physical, emotional, social and spiritual development of girls who have been cut and the long-term consequences for them in terms of their ability to develop safe, trusting and fulfilling relationships; and on the potentially increased vulnerability girls are exposed to in terms of links to other forms of abuse, self-harm and harmful behaviour.
13 26. As noted above, prosecutions alone will not eradicate FGM in the UK. However, it is still important that when FGM or the risk of FGM is a concern, individuals and agencies refer their concerns to the police to investigate the matter further. Other ways to measure success should also be explored, for example, when rape investigations focus on victim satisfaction. This would encourage police to refer victims for support even in cases where no prosecutions happen. In addition, police should consider how to better support victims more so that they do not suffer the sense of isolation should they choose to report an offence and then give evidence for a prosecution. There are examples in the witness protection scheme that could also be explored.
NSPCC Feb 2014
14 Written evidence submitted by Genital Autonomy
How effective is the existing legal framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
Genital Autonomy is a Human Rights based charity, Reg. No. 1138827 whose mission is to protect all children, females, intersex and males, from harmful practices involving their genitals. The provisions of the United Nations Convention on the Rights of the Child are our major guiding principles. We are concerned that the current Female Genital Mutilation Act 2003 is not readily enforceable for several reasons which we set out briefly below.
1. There is a valid argument that to legislate in respect of females only is incompatible with the equal opportunities legislation both in respect of gender and culture. The majority of cultures that cut girls also cut boys. A person from such a culture might well argue with some justification that the FGM legislation discriminates against their girls by preventing them from fitting in with their culture, after all - we can cut our boys why not our girls? In addition to target only the practice of cutting girls appears to favour groups that only cut the genitals of boys. Given the fact that those countries with specific FGM legislation such as the UK appear to have been less successful in prosecuting offences relating to genital mutilation than those who have relied upon their existing laws relating to assault, such as France and Italy, it is questionable whether such specifically targeted legislation is entirely effective or indeed valid in human rights terms.
2. The UK FGM legislation seeks to prevent genital mutilation or adaptation of all women whether they are of the age to give free consent or not. Thus a doctor operating upon an adult woman who wishes to undergo some form of cosmetic or indeed culturally motivated adaptation to her vagina is as guilty as a doctor who operates on a minor child. Surely any legislation in this area must be based on the ability of the recipient of the treatment to give consent? To legislate otherwise comes close to undermining an adult’s freedom to choose to follow the dictates of her conscience, her culture or indeed to undertake whatever cosmetic improvement she considers necessary. This can properly be criticised. It should be the lack of the ability to give consent which ought to define the offence. If an irreversible procedure can be deferred until the person concerned can give proper consent then that should be the course of action adopted by the legislation.
3. The legislation as it presently stands (FGM Act 2003) is fundamentally weak. It targets only the doctor (section 1) or those who aid, abet, counsel or procure a girl to mutilate her own genitals (section 2). In fact the persons who are generally to blame for children undergoing forms of genital mutilation are those in positions of trust in relation to the child, be
15 they parents, wider family or community elders, yet it appears that they cannot be prosecuted for facilitating, allowing, arranging or permitting the child to undergo such treatment. Under the Sexual Offences Act 2003 it is an offence to arrange or facilitate commission of a child sexual offence with another (section 14), or cause or incite a child to engage in a sex act with another (section 17) or similarly in relation to a person who has a mental disability impeding choice (section 31). As a result of these provisions adults can be and sometimes are prosecuted for doing just that. Again the central issue is the lack of ability of the child or mentally disabled person to give consent. In this respect the law relating to the genital mutilation of such people needs to be redrafted making it absolutely clear that such adults are the subject matter of the legislation. This we believe would provide a huge deterrent to adults in positions of trust in this country who may otherwise be tempted to arrange or facilitate such an operation in the UK . It is curious that section 3 of the FGM Act makes a person guilty of an offence if he aids, abets, counsels or procures a person who is not a UK national or permanent UK resident “ to do an act of female genital mutilation” outside the UK. Why is there not a like provision in relation to those people who aid, abet, (etc) a person “to do an act of genital mutilation” within the UK?
4. Other social legislation should be used to robustly protect children and so avoid criminalising parents and carers (where appropriate). Prohibited Steps orders under the Children Act 1989 have been successfully used in the UK family courts to protect children in many situations. The realisation by parents that we as a society consider that the practice of genitally mutilating children is sufficient to establish “significant harm” to a child so as to justify the intervention of the state and ultimately the use of care proceedings resulting in the removal of the child from its home, might well deter many parents from arranging or facilitating such things. Additionally in family proceedings the standard of proof required to prove that something has happened or may happen is simply the balance of probability whilst in criminal proceedings the prosecution must prove the case beyond reasonable doubt. The family court is used to dealing with activities which happen within the privacy of the home or behind closed doors to this standard of proof and the proving of the arrangement for or facilitation of such an operation by a parent would not pose such obstacles as under the criminal standard of proof.
5. Alongside any of the above measures it would be necessary to provide compulsory education for parents found to have arranged or facilitated the cutting of a child’s genitals and for those who have been found to have made preparations to do so. In addition a Prohibited Steps Order, under the Children Act, could be made to prevent the cutting of second or subsequent child or children. Parents would need to understand that if they failed to comply with the order they would be at risk of losing their children and facing criminal charges as appropriate to the level of harm inflicted, actual, or grievous bodily harm or in the worst cases manslaughter. It goes without saying that GPs and other health professionals and social workers would need to be trained to recognise where mutilation had occurred or
16 where there was a risk of it happening and the system for inter-agency reporting on this issue would need to be tightened.
6. It is difficult to see how a child’s human rights are not breached by non- therapeutic genital modification. The European Court of Human Rights has set a very low threshold for a breach of article 3 – that no one shall be subjected to torture or to inhuman or degrading treatment or punishment - for example the application to the court No. 9078/06 Tarhan v Turkey (17/07/2012) found that the applicant’s Article 3 right had been breached by the forced shaving of his head and beard. Children are equally entitled to the protection of their human rights. There is a misuse of Article 9 of the Human Rights Act 1998 when adults state that it is their right to manifest their beliefs by modifying their children’s genitals. Article 9 is a qualified right in that a person cannot infringe the rights of another, even if that other is his or her child.
Genital Autonomy Feb 2014
17 Written evidence submitted by the Bar Human Rights Committee of England and Wales
Preface
The Bar Human Rights Committee of England and Wales (BHRC) welcomes the Parliamentary Inquiry into Female Genital Mutilation (FGM) as the UK has an obvious and urgent need to protect young women and girls far more effectively from the risk of genital mutilation. The BHRC has grave concerns about the efficacy of the UK’s response to FGM, and has concluded that the UK has been in breach of its international law obligations to protect young women and girls from mutilation. During the period of the UK’s breach, thousands of British girls and young women have been unnecessarily exposed to the risk of mutilation and have suffered irreparable physical and emotional damage. Many could – and should – have been saved. This constitutes a serious breach of the state’s duty of care. Immediate remedial action must be taken. To this end, the BHRC makes 12 recommendations for urgent implementation.
Kirsty Brimelow QC Chair Bar Human Rights Committee
Dexter Dias QC Chair BHRC Working Group on FGM
18 BHRC Working Group on FGM
Kirsty Brimelow QC Dr Theodora Christou Dexter Dias QC Sam Fowles Felicity Gerry Courtney Perlmutter Charlotte Proudman Zimran Samuel
This report has been considered and approved by the Executive Committee of the BHRC.
19
Executive Summary
3 Key Conclusions
The BHRC has reached three key conclusions in respect of the UK’s response to FGM (1) that the UK has been in breach of its international law obligations to protect women and children from genital mutilation; (2) that the UK will continue to be in breach until an anti-mutilation mechanism that is comprehensive and cohesive is securely in place; (3) that during the period the UK has been in breach, thousands 1 of British national girls have been mutilated since FGM was criminalised in 1985; some of them could - and should - have been saved and their mutilation evidences a serious breach of the state’s duty of care.
Further, the lack of FGM prosecutions – a crucial impetus to the Parliamentary Inquiry - is just one instance of a pattern of systemic failure to protect young women and girls that is detailed in this report. Taken together, these failures have unnecessarily exposed females in the UK to the risk of genital mutilation. This situation cannot continue. Action must be taken immediately. We make 12 recommendations that should be implemented without delay.
12 Recommendations
1. Introduce ‘FGM Protection Orders’ (FGMPOs) 2 modelled on Forced Marriage Protection Orders and Sexual Offences Prevention Orders. FGMPOs would prohibit respondents from carrying out FGM, prevent children at risk of FGM from being removed from the jurisdiction, and ensure the repatriation of survivors from abroad.
2. Criminalise FGM for all children taken out of UK to be mutilated, irrespective of whether ‘settled’ or not: the UK’s legal obligations extend to all children within its jurisdiction - therefore UK organisers of such mutilations should face prosecution, irrespective of the child’s status.
3. Establish an Anti-FGM Unit. 3 There should be a central coordinating institution for the UK’s anti-FGM response, equivalent to the Forced Marriage Unit in the Foreign and Commonwealth Office.
4. Pass a legal requirement for mandatory training and reporting for frontline professionals in regulated services (health, social care, education).
5. Increase resources for combating FGM in accordance with the UN resolution 4 that state responses to the elimination of FGM should be properly resourced.
6. Provide medical and emotional support for survivors. The UK’s international obligations require that effective remedial support for survivors is available, such as reconstructive (reversal) surgery 5 and emotional/psychological support.
7. Challenge cultural justifications for FGM wherever they arise; be clear that this (i) accords with international consensus; (ii) is the stance of the United Nations; and (iii) forms part of the UK’s international obligation to modify cultural or traditional practices that are harmful to women and girls.
1 http://www.newcultureforum.org.uk/home/?q=node/920 2 http://www.legislation.gov.uk/ukpga/2007/20/section/1 3 https://www.gov.uk/stop-forced-marriage 4 http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/67/146 5 http://www.fpv.org.au/advocacy-projects-research/projects/female-genital-mutilation-cutting-in-victoria/
20 8. Launch national awareness-raising campaign which must emphasise that FGM is (i) a gross human rights violation; (ii) a crime and child abuse; (iii) a problem in and for British society, which we have a moral and legal duty to combat.
9. Introduce FGM into the National Curriculum. Education about FGM is required for boys and girls to foster empowerment and personal autonomy among girls and respect for women’s rights and bodies among boys.
10. Create community engagement programmes. Develop a programme of sensitive, properly resourced community engagement projects to change attitudes about FGM. Community members should be encouraged to help run such initiatives.
11. Deprecate the marginalisation of migrant communities. Racially demeaning depictions, whether in press, public or political debate, or through governmental action, further isolate migrant communities and act to perpetuate FGM as a form of social solidarity and identity.
12. Monitor FGM and collect data to fill the knowledge gap about the incidence and distribution of FGM and monitor the effectiveness of the UK’s interventions.
21
The Bar Human Rights Committee (BHRC)
1. The BHRC is the international human rights arm of the Bar of England and Wales. Established in 1991, it is an independent committee of the General Council of the Bar of England & Wales. The Committee functions as an independent, legally qualified observer, critic and advisor, with internationally accepted rule of law principles at the heart of its agenda.
2. The BHRC’s objectives include upholding the rule of law and internationally recognised human rights norms and standards, and supporting practicing lawyers, judges and human rights defenders. In carrying out this work, the BHRC has secured a reputation for legal expertise in the protection of human rights. The BHRC’s reports and written submissions provide valuable tools to legal practitioners around the world and are read widely by policy makers within national and international bodies, thereby assisting in the development of the law.
3. Over the years the Committee has developed expertise in two areas of particular relevance to this Inquiry: the protection, enhancement and vindication of the rights of women and children. This work stream is reflected in the establishment of two specialised units, The Child Rights Unit and the Women’s Rights Unit. 6
4. For the last four years, the BHRC has been working in Nigeria in partnership with UNICEF and has produced training manuals in conjunction with UNICEF and US AID. FGM remains prevalent as a harmful cultural practice throughout Nigeria.7 The BHRC’s work has focused on Child Protection Networks within Nigeria, and one component of the training concerned strategies for eradicating cultural practices that are harmful to children, including FGM. The training involved 5 delegations between 2011 and 2013 delivering training to over 300 delegates from Child Protection Networks and the National Human Rights Commission of Nigeria. The BHRC delegations trained lawyers, police magistrates, social workers and NGOs.
6 More information about the work of the BHRC can be found at http://www.barhumanrights.org.uk/ 7 See UNICEF report for more on FGM in Nigeria: http://www.unicef.org/nigeria/FGM_.pdf
22 The Approach of the BHRC to the Inquiry
5. The chief objectives of the BHRC’s submissions are • to provide an analysis of applicable international law and the UK’s international law obligations in respect of the prevention, prohibition and punishment of FGM; • to make a series of tailored recommendations flowing from that analysis directed at more effectively protecting young women and girls from FGM.
6. We are of the firm view that proper appreciation of the UK’s international law position is relevant to the Inquiry in a number of respects. We start from the position that it is essential to understand that better protection of girls from mutilation is required not just as a matter of good policy, moral necessity, or political fashion, but also by virtue of the UK’s express obligations under international law. Better protection of women and children is thus a democratic demand indispensable to the effective safeguarding of human dignity and bodily integrity and for the enhancement of gender equality.
7. It is the aim of the BHRC that this understanding becomes widely shared by survivors, campaigners, activists, politicians, civil society and those who presently subscribe to the practice of FGM. This is because the fundamentally reactive approach that has dominated the UK’s response for the last three decades, and that has failed thousands of mutilated young women and children, is in breach of international human rights law. This attests to the urgency of the response now required.
8. The BHRC is committed to promoting, educating about and defending human rights. It profoundly believes that being cognisant of one’s rights can be a tool that can in itself empower both survivors and those who would make a stand against this egregious practice. Girls who have been mutilated need to know that what has happened to them is regarded as abhorrent and a serious violation by the international community. Young women who wish to resist mutilation need to know that they have an internationally recognised human right not to be violated.
9. We therefore proceed to offer an analysis of the UK’s international law obligations, and following directly from this make recommendations that have the twin objectives of (1) better protecting girls at risk of FGM by strengthening the UK’s anti-mutilation mechanism and (2) making the UK’s response to FGM conform to international law.
23 Analysis of UK’s International Law Obligations
10. Why is the UK in breach of its international law obligations to protect young women and girls from FGM? What international commitments has it subscribed to?
11. By ratifying the Convention on the Elimination of All Forms of Discrimination against Women 1979 (CEDAW) 8 the UK committed itself to eliminate discrimination against women. FGM unambiguously constitutes one of the most abhorrent forms of discrimination against young women and girls.
12. Further, by virtue of the UN Convention on the Rights of the Child 1989 (CRC) 9 the UK has positive obligations in international law to ensure that children are not subjected to cruel, inhuman or degrading treatment (art. 37). FGM constitutes an irreparable violation of the child’s bodily integrity and physical and psychological health.
13. FGM is also a violation of the UN Convention against Torture 1984 (CAT), 10 which has been ratified by the UK. As such the UK has a positive obligation to take legislative, administrative, judicial or other measures to prevent acts of torture within its jurisdiction (art. 2).
14. Intrinsic to these legal obligations is the requirement that states must not only respond to FGM but respond in an effective way. Passing legislation, as the UK has done,11 remains an insufficient response if implementation is not effective in practice. It needs to be combined with other measures that are necessary to trigger the legislation (by, for example, having adequate mechanisms for frontline professionals to report instances of FGM and thereby provide the police with evidence).
15. This obligation was reinforced in 2010 by the Commission on the Status of Women which resolved that states should ensure the effective implementation of national legislative frameworks and institute adequate accountability mechanisms to monitor the impact of anti-FGM measures. 12
8 http://www.ohchr.org/EN/ProfessionalInterest/Pages/CEDAW.aspx 9 http://www.unicef.org/crc/ 10 http://www.un.org/documents/ga/res/39/a39r046.htm 11 http://www.legislation.gov.uk/ukpga/2003/31/contents 12 http://www.un.org/womenwatch/daw/csw/
24 16. Furthermore, the European Parliament resolved in 2012 that Member States should not only enact legislation, but develop ‘a full range of prevention and protection measures, including mechanisms to coordinate, monitor, and evaluate law enforcement.’ 13
17. Critically, the European Parliament’s Resolution called on ‘relevant UN entities and civil society, through the allocation of appropriate financial resources, actively to support targeted, innovative programmes and to disseminate best practice guidelines that address the needs and priorities of girls in vulnerable situations, including those subjected to female genital mutilation.’ 14
18. This call for adequate resources to combat FGM echoed the stipulation made by the Council of Europe in 2011 that states should allocate ‘adequate resources’ to prevent forms of violence against women, of which FGM is undoubtedly one of the most serious (the ‘Istanbul Convention’). 15
19. Therefore it is beyond argument that international law requires that the UK creates an effective anti-mutilation mechanism that operates in a multi-level and multi-agency way (legal, administrative, educational, health) and that constitutes a proactive - as opposed to tokenistic and reactive - commitment to protecting girls in the UK from FGM.
20. The UK has a legal duty to ensure that such preventative and protective mechanisms are adequately resourced to the maximum extent of available resources (see CRC, art. 4).
21. The anti-mutilation mechanism must be monitored and maintained – the commitment to eliminate mutilation must be ongoing and not just a short-term response to present public concern.
22. Looking at the case of the UK in the round there is very serious doubt whether the UK has complied with these obligations domestically.
23. One of the historic difficulties in combating FGM has been the anxiety about challenging cultural or traditional practices. However, in a General Resolution in 2007, 16 the UN emphasised that custom, tradition or religious beliefs cannot be used as excuses for avoiding the obligation to eliminate violence against women and girls.
13 http://www.europarl.europa.eu/sides/getDoc.do?type=TA&reference=P7-TA-2012- 0261&language=EN&ring=B7-2012-0304 14 ibid. 15 http://www.conventions.coe.int/Treaty/EN/treaties/html/210.htm 16 http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/61/143&Lang=E
25 24. It follows that wherever ‘cultural’ justifications for FGM are advanced they must be challenged and never used as an excuse for the failure to protect young women and girls. It must be made absolutely clear when such challenge is made that the action is in accordance with international consensus and UN policy.
25. Beyond this, the UK must fearlessly implement the international law principle that it is legitimate, necessary and desirable for a state to intervene to modify social and cultural patterns of conduct that result in discrimination against women: CEDAW, art. 5. FGM is a paradigmatic example where entrenched traditional practices that seriously disadvantage and damage women should be modified by a range of interventions.
26. Furthermore, hitherto there has been a lack of a coordinated and comprehensive campaign of awareness-raising domestically that dispels any ambiguity about the status of FGM as a social practice. Fundamental to such a campaign would be the unequivocal message that FGM is not only a serious crime and child abuse, but a fundamental breach of human rights and gender violence against women and girls.
27. Notoriously, not a single prosecution has been brought. But during the ensuing period of nearly thirty years, many thousands 17 of young women and girls who are British citizens or nationals have been mutilated either in the UK or when they have been taken back to the country of family origin. In a recent report, Bindel and colleagues estimated that presently in the UK 170,000 girls aged 15 and over are living with the consequences of FGM. 18
28. However, the lack of prosecutions is simply one instance of a far greater systemic failure that traverses the entire landscape of state institutions and civil society. The UK has failed in 10 critical respects. 19 The UK has failed to provide: 1. adequate education about FGM for boys and girls as part of the National Curriculum; 2. sufficient training for professionals on risk awareness, the law and survivor support; 3. effective and mandatory professional referral systems among regulated services (health, social services, education); 4. sufficient community engagement programmes directed at modifying attitudes to FGM and behaviour in practising communities;
17 http://www.newcultureforum.org.uk/home/?q=node/920 18 http://www.newcultureforum.org.uk/home/?q=node/920 19 See also recent article by Dexter Dias QC, Felicity Gerry and Hilary Burrage detailing 10 reasons why the UK’s FGM law has proved ineffective and 10 solutions: http://www.theguardian.com/commentisfree/2014/feb/07/fgm-female-genital-mutilation-prosecutions-law- failed
26 5. consistent and coordinated institutional protection nationally; 6. acceptable medical and psychological support services for survivors; 7. meaningful data recording systems; 8. appropriate monitoring of intervention effectiveness; 9. adequate institutional resources and funding domestically; 10. necessary institutional conditions and cultures to prosecute those involved in mutilation.
29. When these failures are evaluated against the backcloth of the state’s international commitments, it is plain that the UK has been in breach of its international obligations to protect young women and girls. Taken together, these failures, individually and cumulatively, have unnecessarily exposed young women and girls to the risk of genital mutilation since FGM was criminalised in the UK in 1985. 20 The many thousands of British national girls who have been mutilated since the UK passed FGM legislation in the 1980s have suffered irreparable harm. Some of these young women could – and should – have been saved. Their mutilation evidences a serious breach of the state’s duty of care. This situation cannot continue. Action must be taken immediately.
30. In the Executive Summary, we make a number of recommendations that should be implemented without delay. We now proceed to develop some of them, which are legal in nature.
31. Lack of effective preventative legal mechanisms. As explained above, the UK has positive obligations in international law to act to prevent genital mutilation from occurring. Prevention can occur through three prime mechanisms: 1. Desistance: through education and community engagement; 2. Deterrence: through fear of criminal sanction; 3. Legal interventionism: through court order.
32. Presently the UK lacks sufficiently tailored or targeted legal powers to assist in intervening in cases where FGM is suspected. Better (and mandatory) reporting will alert authorities to cases where serious risk of mutilation is suspected. In these cases, the state’s response would be strengthened by having a series of powers whereby the court could intervene without necessarily recoursing to taking the child into care.
33. We recommend that powers be created broadly equivalent to those available in Forced Marriage. The powers proposed would include:
20 http://www.legislation.gov.uk/ukpga/1985/38/pdfs/ukpga_19850038_en.pdf
27 1. Applying to the court where it is suspected on clear and compelling evidence that the child is at risk of mutilation, and getting an order prohibiting any interference with the bodily integrity of the child; 2. Orders requiring relatives of a child overseas who has been in the UK and is on clear evidence at risk of mutilation to reveal the location of the child so Consular staff can intervene; 3. Power to prevent an at-risk child being removed from the UK; 4. (We would add that there should be a power to repatriate mutilation survivors to ensure they obtain immediate medical and psychological support.)
34. These civil powers would provide a range of injunctive remedies to courts across the country and would have the virtues of being (1) ‘victim’-centric, directed at (rather than prosecution) prevention and protection of the child, and thus embodying the paramount principle of the Children’s Act 1989; 21 (2) flexible and capable of being tailored to the specific facts of the case; (3) nevertheless backed by criminal sanction for breach in a way that is likely to focus the child’s carers on their duty to protect.
35. It is the professional experience of members of the Committee that in respect of family law cases involving honour crime, those vulnerable to threat have been more prepared to come forward when such an approach is adopted. In appropriate cases, the police can apply to the court for disclosure of the judgment and, certainly in child sex abuse cases, this has led to prosecution.
36. Equally in relation to Forced Marriage powers, it is the experience of this Committee that injunctive relief specifically developed for a social problem (such as Forced Marriage) proved effective in a number of respects. The powers have the virtue of being focused on a particular social ill; are easily understood by judges, lawyers and (crucially) those at risk of abuse; and have been subject of specific judicial training in areas of high prevalence. Similar considerations obviously apply to FGM.
37. Further, it should be noted that during the Parliamentary debates 22 on the Forced Marriage (Civil Protection) Bill, the UK’s international law obligations were invoked. Precisely the same logic applies to FGM. An urgent need to protect vulnerable young women and children also exists in respect of genital mutilation.
21 See section 1(1): http://www.legislation.gov.uk/ukpga/1989/41/section/1 22 http://www.publications.parliament.uk/pa/ld200607/ldhansrd/text/70126- 0001.htm#07012689000023
28 38. Non-settled children. Presently it is not a criminal offence under the 2003 Act if a person in the UK arranges for a non-settled child to be taken out of the UK to be mutilated. The UK’s human rights obligations apply to all children within its jurisdiction, therefore anyone in the UK who is arranging for children to be taken out of the jurisdiction to be mutilated should be guilty of a criminal offence. This gap in the law not only fails to reflect the highly mobile nature of the affected communities, but is morally indefensible. This loophole in the law must be closed.
Bar Human Rights Committee of England and Wales
London, 12 February 2014
29 Written evidence submitted by the Local Government Association
The Local Government Association welcomes the Select Committee’s Inquiry into Female Genital Mutilation (FGM). Local authorities are aware of the often devastating impact FGM has on its victims’ mental and physical wellbeing, including the health consequences and are committed to doing what they can to end this form of violence against women and girls. Not only do councils have a role in tackling this issue as a result of their duties to safeguard children, but they are also well placed to work with any communities in their area where FGM is practised to reduce the estimated 20,000 women and girls at risk of FGM in the UK.
The LGA’s Safer and Stronger Communities Board has recently set up a cross-party working group to look at this issue and take forward a programme of work to both understand the issue in more depth and to know what can be done to prevent and challenge these harmful practices.
We will be engaging with a number of different experts, including professionals and the third sector and we hope to produce a set of resources for councils to help them tackle this issue. We would be very pleased to keep the Committee informed of our progress as this work develops.
I know that many councils are starting to develop policies and practices on this subject. In some areas there is developing partnership work which we are examining, and we will look for any good practice we can encourage councils to adopt as they take their work in this area forward.
We will be following the development of the inquiry, and the recommendations it makes will inform the work the LGA does in this area. If you require more information on the LGA’s approach to FGM, please contact Rob Jervis-Gibbons, Public Affairs Adviser in the LGA ([email protected]), or 0207 664 3125 who will be able to assist further.
Yours sincerely,
Councillor Mehboob Khan Chair of the LGA’s Safer and Stronger Communities Board
On behalf of:
Councillor Joanna Spicer (Conservative Group), Councillor Lisa Brett (Liberal Democrat Group), Councillor Philip Evans (Independent Group)
30 Written evidence submitted by 28 Too Many
1. Declaration of Interest 1.1. 28 Too Many is a charity working to end female genital mutilation (FGM) in the 28 countries in Africa were it is traditionally practised and globally, including the UK. 28 Too Many’s primary focus is to research FGM and enable local initiatives to create positive, sustainable change to end the practice. It networks and advocates for the global eradication of FGM, working closely with governments, charities and non-governmental organisations (NGOs) concerned with international development, violence against women and related issues.
2. Executive Summary 2.1. FGM is an ancient and deeply embedded harmful traditional practice which has become a social norm for those who practise it. It is a severe form of violence against girls and women and is recognised internationally as a human rights violation. This written evidence provides our responses to the questions relating to tackling FGM in the UK posed by the Committee and is based on our detailed research, working with women and girls affected by FGM and networking/collaboration with those responding to FGM in Africa as well as the UK and other countries with diaspora communities. 2.2. The response to FGM in the UK has been inadequate and more can be done to protect girls and young women at risk of FGM. In addition high quality support services need to be made available to women identified with FGM. 28 Too Many supports the recommendations for a UK response to FGM as detailed in the Intercollegiate report on Tackling FGM in UK published by the Royal College of Midwives in November 2013. 2.3. 28 Too Many also urges international cooperation as FGM is not a national issue and efforts to end FGM in the UK are dependent on progress against the practice in other countries. Research is necessary on the current situation regarding FGM and how to improve anti- FGM programmes to ensure the acceleration of the elimination of this harmful practice. Knowledge from other countries of the drivers for FGM and what is most effective in tackling should inform the response to FGM in the UK.
3. Questions being addressed by the Committee
3.1. How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK? 3.1.1. As the Committee has identified, FGM is illegal in the UK and there has been specific laws against it since 1985 and it is also covered by the Children’s Act, but there have been no successful prosecutions. This is in a context of an increasing number of girls and women living in the UK who have had FGM or who are at risk of being cut. The current legislative framework is not enabling justice for those who lives are irrevocably changed by this harmful practice.
31 3.1.2. From 28 Too Many’s work with FGM survivors and professionals in criminal justice, health, social care and education there is concern that the FGM Act places a heavy burden on the girl or women who has undergone FGM and shows no insight into the psychological or cultural issues of these usually very vulnerable girls and women. Communities where FGM is practised are usually founded on respect for elders, patriarchal authority and extended family’s rights over the children, where women have very little power over self-determination and young women or girls even less so. 3.1.3. In order to ensure justice for those affected by FGM, this practice needs to be identified as the child abuse, serious assault and sexual violence that it is. Therefore it is essential that, as with other cases of child abuse, that there is an approach to prosecuting FGM which does not place an unbearable pressure on the victims. 3.1.4. Other barriers to achieving successful prosecutions include a lack of coordination and systematic treatment of FGM as child abuse in child safeguarding procedures: cases are not recorded, reported and followed up; and relevant professionals do not have standardised, compulsory training. 3.1.5. In addition the Committee should consider how the legal framework ensures: • temporary residents at risk of FGM are protected and also that temporary residents carrying out FGM are held to account
• clarity and guidance on the status of female genital cosmetic surgery (FGCS) versus FGM
• consideration of the impact of the increased medicalisation of FGM where the practice is justified as it is done by trained medical professionals in sterile conditions. However this does not address the fact that FGM is a human rights violation and even if the immediate health risks are somewhat mitigated there are still immediate and long term implications for the physical and emotional welfare of the girls who undergo the procedure.
3.2. Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention? 3.2.1. Identification of those at risk of FGM is challenging as it is a very complicated and ancient practice and its origins are unclear. Most FGM takes place in or originates from Africa but research shows that across Africa whether or not a girl is at risk of FGM depends on her specific ethnic origins and the particular circumstances of her family. In a few countries such as Somalia, Dijbouti, Egypt and Guinea FGM prevalence is over 90% so FGM is carried out in most families. However, in other countries such as Ethiopia, Kenya, Tanzania and Uganda FGM is unknown in some ethnic groups but almost universal in others. Therefore those working to identify girls at risk need knowledge of countries where FGM is traditionally practised and policies and processes that can cope with the complexities of prevalence rates within countries.
32 3.2.2. Research in Africa has also shown that there is no standard age when girls are at risk of FGM. Traditionally in some communities FGM takes place on infants, others typically cut girls between the ages of 8 and 14 linking the practice to a rite of passage to womanhood and others carry out FGM at the time of marriage. There is also growing evidence that where laws are introduced and tightened, some groups reduce the age of FGM as it is generally easier to hide the FGM when it takes place on younger girls. 3.2.3. In the UK, it is not just girls and women born in other countries who are at risk. Girls born in Britain to British citizens can be at risk if FGM remains a tradition in their families. This is a secret practice and there has been relatively little research to guide those working against FGM in the UK. However, there is growing evidence that FGM is performed in the UK as well as reported cases of British girls being taken overseas for FGM. Particular risk factors can be identified such as:
• girls born to mothers who have had FGM
• girls who have older sisters who have had FGM • girls from communities where FGM is known to be a risk being taken for an extended holiday to a country where FGM is traditionally practised
• talk of a special party or celebration connected to the girl • a visit from an older female relative, possibly an aunt or grandmother, who could be a traditional cutter
• women who have given birth and who have had FGM, particularly Type III (Infibulation) which resulted in them being cut open to give birth and therefore they are at risk of further FGM to be re-infibulated. 3.2.4. Barriers to identifying and reporting those at risk of FGM include: • poor or no clear guidance and training to front line professionals, especially with regard to when to consider a girl at risk
• no statutory requirements on reporting and insufficient monitoring • lack of standardised and statutory sex and relationship education in all schools which includes age appropriate information about FGM
• the secrecy around FGM within communities and lack of funding for targeted outreach work
• recognising that interventions need to be culturally sensitive but ensuring action is not prevented by misplaced concern of offending or stigmatising people from ethnic minority communities
• unclear referral thresholds, particularly within health, education and children’s social services.
• lack of accountability in relation to local performance 3.2.5. The Committee should look at other EU child protection systems of screening girls under 6 years of age. The recent intercollegiate report on tackling FGM in the UK
33 recommends that though the UK may not want to adopt these measures it is “important to underline the principal that in specific situations where there is a suspicion that a girl has undergone FGM and that siblings may also have undergone FGM, a doctor, specialist midwife or nurse trained to recognise the types of FGM should examine girls so that there is a base line in case the suspicion arises later. There needs to be understanding by all agencies that an examination is part of a whole health assessment. In the experience of the Royal College of Paediatricians and Child Health child protection standing committee, children and their parents do not find such examination traumatic.”
3.3 What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved? 3.3.1 Efforts to tackle FGM in the UK have been disjointed and sporadic but over the last departments and other agencies. Mulit-agency guidelines on tackling and preventing FGM were issued by the Department of Health in 2011 but these have not been effectively disseminated and implemented across all relevant agencies. Many professionals are not aware of the guidelines. 3.3.2 The lack of education, training and clear procedures for tackling FGM, including identifying and safeguarding those at risk, results in many situations where the first time professionals have to deal with a case involving FGM it is a crisis intervention. This highlights the need for a stronger focus on safeguarding and preventative measures as well as improved training and procedures for responding to urgent cases. 3.3.3 The Committee should look carefully at the strong policy recommendations for the main agencies involved in the response to FGM that were made in the recent Intercollegiate report on Tackling FGM in the UK. From 28 Too Many’s work and research we support these recommendations and agree that there needs to be a strongly led and coordinated national action plan on FGM and clear local accountability to ensure the necessary cooperation and collaboration between all the agencies involved in FGM prevention and support to survivors.
3.4 How can the systems for collecting and sharing information on FGM be improved? 3.4.1 FGM is a serious human rights violation as well as being an especially severe form of violence against women and girls. Therefore it is essential that there are clear lines of accountability for recording, reporting, referral and inter-agency information sharing on FGM. It is recommended that a national action plan, standardised and statutory reporting and mandatory training for frontline professional are implemented as a priority. 3.4.2 28 Too Many supports the recommendations in the Intercollegiate report on Tackling FGM in the UK which highlights that “a robust data system should be developed for surveillance, auditing and monitoring of FGM by those who are charged with leading a
34 preventative response. By implication, this system should also consider the mobility of populations, particularly where there may be a large refugee cohort. Other child protection mechanisms allow for a records audit, so that practitioners can identify what previous interventions to prevent abuse have been taken.”
3.5 How effective are existing efforts to raise awareness of FGM? 3.5.1 Existing efforts to raise awareness of FGM in the UK have been largely initiated by the third sector and have been limited in impact due to very restricted funding and resources. Until very recently, there has been very little media attention given to FGM. However this now appears to be changing and in response to continued campaigning by anti-FGM activist there are campaigns on FGM being run in the mainstream media. 3.5.2 Even where there is some investment such as the launch of the Home Office “Statement on FGM” and the NSPCC national telephone helpline for FGM, there was insufficient publicity and promotion for the public and especially harder to reach diaspora communities where there is a high risk of FGM. In addition many professionals do not know of these initiatives or other resources available to help tackle FGM let alone those from at risk communities. 3.5.3 There needs to be clear focus on the different target audiences for FGM messages and recognition that general awareness raising campaigns are unlikely to reach or be effective with those in communities where FGM is practised. For example, whilst general awareness raising has been achieved by a series of articles and editorials in the London Evening Standard over the last 12 months, such articles do not have significant impact on those for whom FGM is a social norm. Research in Africa has shown that tackling FGM requires a range of responses from law enforcement, central coordination, health education and culturally sensitive community discussions/engagement.
3.6 How can the available support and services be improved for women and girls in the UK who have suffered FGM? 3.6.1 FGM results in physical and psychological trauma for those who experience it. High quality training is essential for all frontline professionals who might be involved in supporting girls and women affected by FGM and should be statutory, including clear guidance on appropriate referral procedures so that those in need quickly receive the necessary support. 3.6.2 In particular all girls and women identified with FGM should be sensitively referred for support and medical/psychological assessment as appropriate. They need to be given clear information on the effects of FGM (health, psychological, and rights-based) and the support available to them. Referral pathways must be developed so that all health and social care agencies are aware of their respective roles and responsibilities.
35 3.6.3 It is also very important that support services are youth accessible and staff trained to deal with young girls who may be seeking support without parental knowledge or support. This includes ensuring good sex and relationship education in all schools so that girls affected by FGM are able to seek out help and take vital first steps to protect themselves and/or seek help if they have had FGM. 3.6.4 There needs to be investment in specialist support centres such as the African Well Women Clinics as well as counselling and community based support groups which can provide long term support to girls and women living with the consequences of FGM.
4 General comments 4.3 28 Too Many welcomes the Committee’s inquiry into FGM and hopes it leads to better protection for those at risk, increased support for those who have experienced FGM and lasting change to end the practice in the UK and globally. 4.4 We are happy to provide further evidence to the Committee as required based on our research on FGM and our experience working those affected by FGM in the UK, Africa and global diaspora. References
Country Profile FGM in Kenya, 28 Too Many, May 2013 Country Profile FGM in Uganda, 28 Too Many, July 2013 Country Profile FGM in Ethiopia, 28 Too Many, October 2013 Country Profile FGM in Tanzania, 28 Too Many, December 2013 Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change, UNICEF, July 2013 Female Genital Mutilation Legal Guidance, Crown Prosecution Service website Female Genital Mutilation/Cutting in Somalia, Worldbank and UNFPA, 2004 How the methods used to eliminate footbinding in China can be employed to eradicate female genital mutilation, Dr Ann-Marie Wilson, 28 Too Many, May 2012 Tackling FGM in the UK, Intercollegiate recommendations for identifying, recording and reporting, published by The Royal College of Midwives, November 2013 UN Report to the UN General Assembly on The Girl Child, 2009 Working to end Female Genital Mutilation and Cutting in Tanzania – the Role and Response of the Church, Tearfund, 2013, research by 28 Too Many
28 Too Many
Feb 2014
36 Written evidence submitted by the International Association of Women Police
Executive Summary
The issue of FGM is one that the IAWP has campaigned about for many years. Some of our members around the world are actively involved in tackling this issue along with providing support to victims.
This submission includes evidence from our own research and interviews with people working to tackle FGM as well as information sent to us from police officers. It also includes examples of how authorities in other countries are tackling the issue, for example France, where more than 100 adults have been jailed for committing or permitting FGM.
It is clear to us that here in the UK a robust multi-agency framework is needed to enable partners to work together more closely. Health and education providers play a key role here as they are often the first people to become aware of a victim of FGM. They need to have confidence in a criminal justice and child safeguarding process that will investigate and prosecute offenders as well as protecting and supporting victims.
Education is vital, both within communities and amongst professionals from health, education, police, social care and prosecutors.
A high profile awareness raising campaign is essential to make communities aware of the consequences of practicing FGM and that it is not cultural but criminal. The campaign should aim to empower girls and young women giving them confidence to report FGM.
Professionals must be given all the necessary information about FGM to enable them to act. The Daughters of Eve charity reports of receiving emails from teachers who have had a child tell them FGM is going to happen, or has already happened and because there are no safeguarding guidelines in place they email the charity asking them to deal with the case. This is shocking.
How effective is the existing legislation framework on FGM and what are the barriers to achieving a successful prosecution in the UK?
1. It is ludicrous to suggest that any reported cases of FGM are not followed through as rigorously as possible. The fact that there have been no convictions points one in the logical direction that there is a problem not only in identifying victims and cases of FGM but also in achieving successful prosecutions against the perpetrators of this crime. However, the more pertinent question appears to be not whether the current law is suitable to apportion blame, after all one does not ask whether the Theft Act is sufficient to impeach thieves, but rather what are the barriers which have so far prevented any prosecutions. At present these barriers seem to be plentiful and complicated ranging from the age of the victim, pressure from the family and wider community to remain silent and a lack of knowledge and understanding from professionals entrusted with the safeguarding of children.
2. Getting a prosecution is vital in achieving justice for a young woman or girl who has been abused - but the reason we have never had one in the UK is not because the
37 police or CPS are not doing their job. The police and the CPS are at the very end of the process. They need information from either a victim, which isn't easy; or from somebody who is responsible for safeguarding that potential victim.
3. The main reason we have not had a prosecution for FGM is because countless individuals who are charged with protecting girls from harm, teachers, social workers, health professionals and anyone and everyone who comes into regular contact with children - either do not have enough information or, worse, do not feel accountable for child safeguarding on this issue.
4. The guidelines regarding prosecuting without the victim giving evidence should be made more robust, the emphasis needs to be taken away from the victims where they are young girls. Consideration should be given to a default position of prosecution, not for prosecution to be the exception.
5. It can also be dangerous to hang everything on gaining a prosecution, after the first, what then? Will some consider the problem solved? Safeguarding potential victims should take priority; we need to prevent any more girls suffering this abuse.
6. We believe that to create the biggest impact on tackling FGM in the UK more needs to be done to protect girls being taken from this country for the procedure to be carried out abroad. There must be improved cross border working, linking with the relevant agencies in the countries where FGM is still part of the culture as well as any other countries where the procedure is found to be taking place on girls from the UK. This is particularly important on the lead up to and during UK School holidays to support operations taking place here at exit points from the UK. Opportunities exist for UK authorities to work with the International Association of Women Police (IAWP) to enable links with law enforcement agencies in these countries, particularly female police officers who are often the champions of tackling gender related crime within their local communities. Police women's networks and associations have an important part to play in this.
7. A fear of being accused as racist appears to prevent reporting by certain professionals, this was identified as a potential problem 10 years ago within Home Office circular 10/2004.
Which groups in the UK are most at risk of FGM (whether in the UK or abroad) and what are the barriers to identification and intervention?
8. Due to the hidden nature of the crime it is difficult to quantify exactly how many women and girls have been affected by FGM, especially considering that it is common place for girls to be taken abroad to undergo the procedures. However it is known that the procedure is associated with communities in Africa, particularly Mali, Somalia, Sudan, Egypt and Kenya, as well as some parts of the Middle East.
9. According to the Home Office's own figures more than 2,100 female genital mutilation victims have sought help at London hospitals in just three years, with over 300 victims requiring surgery to repair damage caused.
38 10. Dr Comfort Momoh, a specialist in dealing with these injuries at St Thomas’ Hospital,
said: “These statistics show a very significant number of women are being treated for FGM. But there are still lots out there who are not being identified. For too long, it has been passed off as a "cultural" ritual. But this act is not about celebration. FGM is gender-based violence; it's as simple as that.”
11. There appear to be a number of barriers towards identification and intervention, not least the fact that this practice is not one of neglect or sadistic abuse, in fact the perpetrators frequently act out of love believing the practice to be necessary to ensure the chastity and acceptance of the female within that community. Girls are not considered suitable for marriage unless they have undergone this procedure and in a culture where marriage is pivotal to the amelioration of the community these longstanding beliefs are hard to shake.
12. Awareness amongst these groups should start at the point of entry for new immigrants entering the UK if nothing else but to gain intelligence for future monitoring of girls within the family.
What are the respective roles of the Police, health, education and social care professionals, and the third sector and how can multiagency co-operation be improved?
13. Because traditionally reports have been low FGM is not well understood or widely publicised. It has previously been suggested to be a low-level, low priority crime with people frightened of confronting the issue head on for fear of being labelled a racist. But this means that girls from some backgrounds are less protected from violence than others. There needs to be an education and awareness raising campaign to ensure schools, health authorities, social services and the Police tackle the issue.
14. The reality is that FGM is child abuse and thus needs to be tackled in a similar way to any other reported case. What is shameful is that with all the recommendations put forward and implemented in the last twenty years to tackle such a plethoric issue nothing has been done to improve the multiagency approach in the eradication of FGM.
15. The all Wales Child Protection procedures report of 2005 as an example states that FGM places a child at risk of significant harm and should therefore be investigated (initially) under Section 47 of the Children Act (1989) by Social Services and the police child protection team. However this appears to be a somewhat basic approach with a more realistic and appropriate method conferring responsibility on all the agencies currently responsible for the safeguarding of children including health and education so that this barbaric practice can truly be eradicated.
16. Not only do systems need to be put in place at a statutory level but data needs to be gathered by teachers, social workers and health professionals on girls at risk and the government must ensure that everyone is made to do their part. All relevant agencies should work with the practicing communities to develop appropriate education and preventive programmes with a view to eradicating the practice of FGM.
39 17. All staff who have responsibility for child protection work should be acquainted with any local preventative programmes that exist. Any information or concern that a child is at risk of, or has undergone FGM must result in a child protection referral to social services and/or the police. MASH – Multiagency Safeguarding Hubs - must be routinely implemented in geographical locations where there is a high concern about the practice of FGM to offer a preventative and protective environment for vulnerable children. These bring together Safeguarding Professionals in one secure location, including Children Services, Health, Education, Probation and Police.
18. Daughters of Eve is an independent charity set up to combat FGM within the communities affected and help the victims. A spokesperson from the charity said: “We receive emails from teachers who have had a child tell them that FGM is either going to happen, or has already happened. Because there are no safeguarding guidelines, they email a small charity like ours, and ask us to deal with the case. I find that pretty shocking.”
19. The national helpline set up for FGM is receiving more and more contacts, percentage wise a large number of teachers are contacting it for advice. This demonstrates a need for awareness training in education. In addition the helpline should be widely publicised.
20. Children at risk - or affected by - FGM spend half their time in school. Their teachers are their world. Those same teachers need to feel accountable for dealing with this extreme form of child abuse.
21. There needs to be mandatory training for staff across all agencies, general awareness training for front line staff as a minimum with specific training for specialist staff. In particular Education needs to play a full part in this, teachers have a critical role to play both in intelligence gathering and reporting. They know what to do when other forms of child abuse are disclosed to them; FGM must be treated in the same way. Children also need to understand that FGM is not acceptable and that it should be reported in the same way that they are taught about other dangers. We are pleased that Education Scotland are writing to all head teachers on the subject of FGM however we believe what happens in our schools should be led centrally not left to individual head teachers.
22. We understand the Department for Education wants to reduce the amount of national guidance it imposes on schools but we believe, in the case of FGM, it is vital that mandatory expectations are issued from the very top. We are pleased to hear that the Secretary of State for Education, Michael Gove has now agreed to meet with a campaigner who wants the subject of FGM included in schools. We look forward to hearing of the outcomes of that meeting in due course.
23. The Crown Prosecution Service (CPS) published guidance for prosecutors in September 2011. In November 2012, the Director of Public Prosecutions published a CPS action plan on improving prosecutions for FGM. In 2011 The Welsh assembly produced an All Wales safeguarding children document which sets out excellent
40 recommendations for the future policing of FGM. However these resources appear to have been under-used.
24. Multi agency co-operation needs to be led at government level with statutory requirements placed on individual agencies.
25. Lessons and best practice can be learned by looking at how other countries are tackling the issue. In Ontario, Canada, a duty to report FGM exists under the policy of the College of Physicians and Surgeons of Ontario (CPSO) and under the Child and Family Services Act. Under CPSO policy, the performance of female circumcision, excision, infibulation and/or re infibulation by a physician licensed in Ontario, unless medically indicated, would be regarded as professional misconduct. Under Ontario's Child and Family Services Act there is a duty to report information with respect to a child who is in need of protection. This duty applies to all members of the public and those who perform professional or official duties in relation to children.
26. More responsibility must be placed on professionals in all the agencies to remove the reliance on victims to report.
How can systems for collecting and sharing information on FGM be improved?
27. FGM data must be collected across all sectors and should be specific for the crime so it is not hidden within other data as is often the case now.
28. Established child protection systems need to be used for FGM, the same as for any other form of child abuse.
29. Data needs to be collected on how many potential victims of FGM have been safeguarded, there does not seem to be such data readily available, a Freedom of Information request is currently with the Home Office and Ministry of Justice. We believe it is important to show how many girls have been protected, after all if a prosecution takes place it means those charged with safeguarding them have failed if the prosecution results from FGM having taken place.
How effective are existing efforts to raise awareness of FGM?
30. Whilst we recognise a lot of work has gone on in raising awareness, much more needs to be achieved both within the communities that practice FGM and amongst professionals across Police, Social Care, Health and Education. FGM must be viewed as criminal not cultural.
31. More effort needs to be put to ensuring relevant communities are aware that the practice ultimately amounts to child abuse and of all the consequences, not just that they can be prosecuted. They also need to be aware of the health consequences resulting from the practice; the child could be placed under a child protection order; entered on the 'At Risk Register' and there may be future monitoring of their siblings.
41 32. A successful prosecution, along with the publicity surrounding it, could assist women within affected communities to resist pressure to subject their daughters to FGM. For example, from research we have conducted, we are told that within the Somali community in the UK there are many who do not want their daughters to go through FGM but they succumb to community and peer pressure. If they are able to state very clearly that the practice is against UK law, and show that others have been prosecuted for the offence, it may help them to resist the pressure.
33. If children were taught in schools about FGM at the same time as they are taught about other violence issues it would avoid the issue being seen as a problem specific to only a particular group. It would also emphasise to potential future victims that the practice is wrong.
How can the available support and services be improved for women and girls in the UK who have suffered from FGM?
34. It is very rare that, due to cultural issues and age issues, this type of crime would ever be directly reported to the police by a victim at the time. With this in mind we need to take a multi-agency approach in tackling the issue, similar to the one already adopted in child abuse cases whereby medical intervention and information sharing needs to be at the forefront even more so than ever before.
35. The French had a similar problem but have jailed more than 100 adults for committing or permitting FGM. Health reviews there include compulsory checks that female circumcision has not been carried out: incidents are falling significantly. A recent similar crackdown in Holland, say Dutch campaigners, resulted in more than 10,000 Somalis leaving their country — for the UK.
36. In November 2012 the government launched a 1 year pilot of the statement opposing female genital mutilation (FGM). The statement opposing FGM, which is currently used in Holland and known as the ‘Health Passport’, is pocket-sized and states the law and the potential criminal penalties that can be used against those allowing FGM to happen. In Holland, it is primarily used by families who have migrated to Holland and do not want their children to be subjected to FGM, but still feel compelled by cultural and social norms when visiting family abroad. It is also used by young girls, typically aged 13 years or over, who can carry the document with them when they are abroad with their family.
With thanks to all who assisted our research in particular:
Lysiane Brassard, IAWP member based in Canada Nancy Osborne, UNICEF and IAWP member based in New York Superintendent Helen Chamberlain, member of the British Association of Women Police (BAWP) Temp DCI Kim Madill, BAWP member Commander Mak Chishty, ACPO Lead (FGM) PC Sally Mulvaney, BAWP member
42
On behalf of the International Association of Women Police (IAWP) by Jane Townsley, President of the IAWP
43 Written evidence submitted by Lisa R. Avalos, Assistant Professor of Law at the University of Arkansas at Fayetteville, USA
Reviewing the United Kingdom Policy Framework on Female Genital Mutilation:
Opportunities for Change
Declaration of Interests. Lisa R. Avalos is Assistant Professor of Law at the University of Arkansas and has authored this evidence. My research focuses on international human rights with an emphasis on women’s human rights, gender-based violence, and sexual violence. I work with international nongovernmental organizations to develop policy solutions that address persistent human rights violations such as rape, child marriage, and honor-based violence.
This evidence is part of a larger report that I am authoring as part of a collaboration with FORWARD UK; the larger report will launch later this year.
FORWARD (the Foundation for Women’s Health, Research and Development) is an African Diaspora women's campaign and support charity registered in the UK. FORWARD was established in 1983 in the UK, in response to the emerging problems caused by female genital mutilation being seen by health professionals. Since this time FORWARD has been working to eliminate the practice and provide support to women affected by FGM.
Executive Summary/Table of Contents. This written evidence summarizes information from my larger forthcoming project on how Britain can create an enabling policy and legal environment for ending FGM.
The evidence that follows covers recommendations on the following issues:
A. Adopting a National Action Plan to End FGM
B. Legal and Policy Measures
1. Revising the 2003 FGM Act 2. A Proposed Model FGM Act 3. FGM Prosecution Under the Domestic Violence, Crime and Victims Act of 2004
C. Working with Communities
1. The Female Genital Mutilation Initiative 2. Telephone Helpline for FGM 3. Feedback to the Government on the Health Passport 4. Establishment of a National Advisory Board Comprised of Individuals From Affected Communities
D. Competency Building Among Relevant Professionals E. Provision of Specialist Health Services to FGM Survivors F. Recommendations
44
1. Legal and Policy Measures 2. Recommendations for Working with Communities 3. Recommendations for Working with Professionals
A. National Action Plan to End FGM
A national action plan for ending FGM would address the “big picture” and accordingly serve a number of purposes. It would provide a mechanism for the government to coordinate all anti-FGM efforts across sectors and ensure that all stakeholders are included in planning. It also would provide a system for disseminating best practices across sectors and organizations, while allowing stakeholders to avoid duplication of effort. Because national action plans against both FGM and gender-based violence are being developed in several EU member states, these plans provide a way of allowing countries to compare initiatives and share best practices. FGM is a complex problem, and a national action plan provides a mechanism for coordinating the range of responses that the problem requires.
A comprehensive national action plan should include: (a) legal measures, (b) work with communities on FGM-abandonment through education and knowledge transfer, (c) equipping professionals with the education and resources they need to effectively intervene, (d) the provision of specialist health services for FGM survivors, and (e) the coordination of international efforts against FGM. Some of these issues are addressed below.
B. Legal and Policy Measures
The UK can strengthen the 2003 FGM Act and use the Domestic Violence, Crime and Victims Act of 2004 to augment efforts to prosecute FGM.
1. Revising the 2003 FGM Act
The UK is a signatory to international agreements that require legal measures against FGM that go beyond the protections provided in the 2003 FGM Act. The European Parliament has called upon member states to mandate a full range of measures to prevent FGM and protect those at risk, including (a) mechanisms to coordinate, monitor and evaluate how law enforcement responds to FGM1 and legislative measures that (b) require physicians and other health care professionals to report cases of FGM to the police, (c) enable judges or public prosecutors to issue protective orders if someone is at risk of FGM, and (d) that prosecute and punish any resident (not just any citizen or permanent resident) who commits FGM, even if the act was committed extraterritorially.2
In addition, the Istanbul Convention requires state parties to adopt legislative measures to ensure that certain aggravating circumstances be taken into account when sentencing
1 European Parliament resolution of 14 June 2012 on ending female genital mutilation, paragraph 4. 2 European Parliament resolution of 24 March 2009 on ending female genital mutilation, paragraphs 20, 21 & 28.
45 perpetrators.3 It also calls upon state parties to adopt legislative measures to provide victims of gender-based violence (including FGM) with civil remedies, including compensation, against perpetrators of such violence as well as civil remedies against state authorities who fail in their duty to protect.4
The UK should also take into account recent FGM laws enacted in Ireland (2012), Kenya (2011) and Uganda (2010), all of which are more robust than the 2003 FGM Act because they incorporate measures criminalizing a range of acts that facilitate FGM. These newer laws expand the range of prosecutable offences.
The Model FGM Act incorporates guidance from all of the sources discussed above. It adopted, it would expand the potential for prosecution and strengthen the protection afforded to FGM victims and those at risk. The proposed Model FGM Act is included with this paper in the Appendix.
2. The Model FGM Act (the “Model Act”)
The Model Act uses the World Health Organization’s definition of FGM – including the idea that FGM is a set of procedures performed for nonmedical reasons. Use of this definition eliminates the need for language allowing exceptions for permitted medical procedures. The Model Act also incorporates a provision extending extraterritorial protection and prosecution to anyone ordinarily resident in the UK, not just citizens and permanent residents. These drafting choices achieve greater clarity and bring the law in line with international standards on FGM.
The Model Act also states that FGM is child abuse. This clarification helps relevant professionals make the connection that all legislation preventing and punishing child abuse also applies to FGM.
The Model Act describes the following offences involving female genital mutilation:
• Female genital mutilation. Describes an offence of female genital mutilation as well as an aiding and abetting offence for FGM. These provisions are similar to similar sections in the 2003 FGM Act but are more streamlined. This approach greatly increases clarity and eliminates the possible argument that the law permits FGM if it is carried out in connection with childbirth.5
• Aggravated female genital mutilation. Creates a new offence of aggravated FGM for cases where FGM results in death, disability, HIV infection, or for cases where the offender is a health care professional, parent, or other person with authority or control over the victim.6
3 Istanbul Convention, Art. 46. 4 Istanbul Convention, Arts. 29-30. 5 Female Genital Mutilation Act, 2003, c. 31, §(1)(2)(b) (Eng., Wales, N. Ir.). 6 Uganda, The Prohibition of Female Genital Mutilation Act, 2010, Section 3, “(Aggravated female genital mutilation).”
46 • Use of premises or possession of tools used in FGM. Criminalizes the use of premises and the possession of tools for the purpose of FGM. These provisions expand the range of charging options available to law enforcement.
• Discrimination or harassment for rejecting FGM. Criminalizes discrimination or harassment of any kind when it is directed at a person who resists or refuses FGM, or her close family members. This section also criminalizes acts of harassment directed at those who speak out against FGM. It creates a remedy for those who face harsh treatment for rejecting FGM and simultaneously sends the message that harassment and discrimination against those who reject FGM will not be tolerated.
• Facilitating FGM through arranging travel. Criminalizes the act of arranging for another person – whether a potential perpetrator or a potential victim – to enter the UK for the purpose of either performing or receiving FGM, as well as the removal from the UK of a girl or woman for the purpose of enabling her to undergo FGM outside the UK. These provisions address the fact that FGM is a cross-border problem. Accordingly, criminalizing the facilitation of FGM through travel arrangements expands opportunities to bring a prosecution.
• Extraterritorial liability extended to all residents. The Model Act creates extraterritorial liability for the above acts when those acts are committed by a UK national, permanent resident, or person who is ordinarily resident in the UK.
Part Three of the Model Act describes prohibited defences and penalties for offences. The belief that FGM is required as a matter of custom, ritual, or religion is not a defence. Part Four of the Model Act describes obligations to report FGM to the authorities and penalties for failure to report:
• Reporting obligations. The Model Act requires any adult person with knowledge that FGM has occurred or will occur to report that information to the police or other authority within twenty-four hours.
• Safeguarding obligations. The Model Act states that professionals working with children, upon becoming aware of a suspected case of FGM affecting a child, must follow the child protection procedures mandated in cases of child abuse. It also requires any professional who becomes aware of a case of FGM affecting a child to report the case to the relevant health care authorities. These health care authorities are then obligated to make arrangements to ensure that the affected child has access to appropriate specialist health services.
Part Five of the Model Act addresses court orders and jurisdiction:
• Compensation and civil remedies. The Model Act empowers courts to order that a perpetrator pay compensation to a victim. It also provides victims with civil remedies such that they may recover damages and attorneys’ fees from perpetrators.
47 • Orders of protection. It empowers courts to issue an order of protection when the court becomes aware of a person who is at risk of being compelled to undergo FGM.
Part Six of the Model Act sets out additional measures that the government must take towards eliminating FGM.
• Education and specialist health services. The Model Act sets out obligations to provide education on FGM both to the general public and to professionals who may work with those affected. It also mandates the provision of specialist health services to FGM victims.
• Making information on FGM available to immigrants. The Model Act provides that the United Kingdom Border Control Agency shall make available to immigrants from FGM-affected communities information about the severe harm caused by FGM and the potential legal consequences for allowing a child to undergo FGM.
Why adopt the Model FGM Act? The Model Act provides a more robust framework for prosecuting FGM than the current law. It expands the number of offences available to prosecutors, and it enhances the extraterritorial protection so that anyone ordinarily resident in the UK can be prosecuted for inflicting FGM even if that person is not a citizen or permanent resident. It also eliminates confusing language so that the law is easier to understand.
3. FGM Prosecution Under the Domestic Violence, Crime and Victims Act of 2004
The Domestic Violence, Crime and Victims Act of 2004 (the “DVCV Act”) may be used in situations where: (a) a child or vulnerable adult either dies or suffers serious physical harm, (b) the harm is the result of an unlawful act of an adult who is a member of the same household or who had frequent contact with the victim, and (c) more than one adult falls into this category and it is not clear which one caused the harm.7 Under the DVCV Act the prosecutor can make a case against any of the adults in question for failing to protect the victim. The prosecutor need only prove that the person charged either caused the death or was aware (or ought to have been aware) of a foreseeable risk to the victim, and failed to take steps to protect the victim.8 The DVCV Act is a promising avenue to prosecute FGM because it enables prosecutors to bring charges against parents who fail to protect their daughters from FGM even if the parents do not carry out or arrange the procedure themselves. The DVCV Act has certain limitations which are discussed more fully in the full paper.
C. Working with Communities
7 Domestic Violence, Crime and Victims Act 2004, Section 5(1); Explanatory Notes, Domestic Violence, Crime and Victims (Amendment) Act 2012, para. 4. In 2012, the DVCV Act was amended to cover instances of serious physical harm to a victim in addition to death. 8 Domestic Violence, Crime and Victims Act 2004, Section 5(1); Explanatory Notes, Domestic Violence, Crime and Victims (Amendment) Act 2012, para. 8.
48 Communities are integral to the success of anti-FGM measures. The European Commission has noted that ending FGM must include implementing measures that promote sustainable social change. The Commission has stated that legal measures against FGM are necessary but not sufficient to ensure that FGM is abandoned. Rather, “[c]hanges in attitudes and beliefs among relevant communities are needed.”9 Community-based prevention and education efforts on FGM can take a very wide range of approaches, a number of which are discussed below. Adequate funding must be made available in order to ensure that a wide range of strategies can be explored and then evaluated for effectiveness. Those that are most effective should be expanded, as appropriate, for use in as many communities as possible. The Female Genital Mutilation Initiative, as discussed below and in the paper, aims to support innovations in preventing FGM. In addition, in March 2013 the UK government pledged £35 million to combat FGM, and they have also started a telephone helpline and have piloted a health passport. These efforts are discussed in the sections that follow, along with this paper’s proposal to create a national FGM advisory board.
1. The Female Genital Mutilation Initiative (the “Initiative”)
Many anti-FGM efforts at the community level are currently supported by the Female Genital Mutilation Initiative – a major anti-FGM initiative largely funded by private sector organizations (the Esmée Fairbairn Foundation, Trust for London, Comic Relief and Rosa, the UK Fund for Women and Girls) with the goal of eliminating FGM across the UK. The groups funded by the Initiative bring a wide range of approaches and have adapted their strategies to the particular community contexts in which they operate. Funded groups have enjoyed high levels of success in communicating information about the negative health consequences of FGM. They have succeeded in breaking some of the silence around FGM and creating community spaces to discuss FGM, its negative effects, and reasons for abandoning the practice.10 As the work has progressed, the Initiative has also identified challenges that must be addressed going forward, in particular:
• FGM as a religious requirement. Many groups have found that the people in affected communities widely hold the belief that FGM is a religious requirement. Activists see a need to build deeper cooperative relationships with religious leaders and communities.
• Less severe forms of FGM are widely embraced. Groups have found that as more people turn away from more severe forms of FGM, many view the less severe forms as more acceptable.11 Anti-FGM groups have found this stance to be a challenge for two reasons. First, the less severe forms are often described as “sunnah,” or a religious requirement, and second, community members have been receptive to health arguments against FGM but they also argue that the health arguments do not apply as strongly to
9 “Communication from the commission to the European Parliament and the Council: towards the elimination of female genital mutilation,” European Commission COM(2013) 833 final, 25 November 2013, p. 6. 10 The FGM Initiative, Interim Reports, October 2011 and September 2012. 11 The FGM Initiative, Interim Report, October 2011, p. 39.
49 lesser forms of FGM.12 These arguments are very compelling for many in affected communities and is a significant barrier to eliminating FGM.13
• Confusion about FGM versus female cosmetic genital surgery. Groups working against FGM have asked for clarification regarding the legal position of procedures on the genitals carried out for reasons of custom or ritual versus those carried out for cosmetic reasons.14 This issue is addressed in Part 5 below.
• Educating physicians and building referral networks. Groups have reported mixed success in approaching physicians.15 Physicians should play a key role in the fight against FGM, but not all physicians have been receptive to the overtures of anti-FGM groups.16
• The need to incorporate a human rights based framework. Grounding arguments against FGM in human rights, rather than in terms of health, allows activists to make more expansive arguments.
In addition to the challenges highlighted above, the Initiative has noted that there is no effective national policy on the role of local authorities in tackling FGM.17 This finding supports the need for a national action plan on FGM.
The government has a crucial role to play in creating an enabling environment for community-based anti-FGM initiatives. It must ensure adequate levels of funding, in keeping with the mandate from the UN General Assembly to “allocate sufficient resources to the implementation of policies and programmes and legislative frameworks aimed at eliminating female genital mutilations.”18 Efforts to eliminate FGM should benefit from public sector funds; the burden should not be on the private sector to sustain these important initiatives. The government also should facilitate community organizations’ efforts to build relationships with key individuals and groups in other sectors – in particular the statutory sector, and with relevant professionals from the health, education, and social services sectors.
2. Telephone Helpline for FGM
12 The FGM Initiative, Interim Report, October 2011, p. 42. 13 The FGM Initiative, Interim Report, October 2011, p. 42. 14 The FGM Initiative, Interim Report, October 2011, p. 7. 15 The FGM Initiative, Second Interim Report, September 2012, p. 19. 16 The FGM Initiative, Second Interim Report, September 2012, p. 19. 17 “Tackling Female Genital Mutilation in the UK: What works in community-based prevention work,” Female Genital Mutilation Initiative, July 2013, available at http://www.trustforlondon.org.uk/special-initiatives/female- genital-mutilation-fgm/. 18 “Intensifying Global Efforts for the Elimination of Female Genital Mutilations,” Resolution of the United Nations General Assembly, 67th Session, 16 November 2012, para. 14.
50 The NSPCC children’s charity established a free, 24-hour FGM telephone helpline in June 2013.19 Within its first three months of operation, the helpline received 93 calls, coming from members of affected communities as well as from education and health care professionals seeking advice.20 Although this is a very new initiative and information about its effectiveness is limited, the helpline does appears to be a useful way of increasing referrals to the police as well as providing information to those affected by FGM. It also fulfils the Istanbul Convention’s call to establish 24-hour telephone helplines for those affected by gender-based violence.21
3. The Health Passport
The government issued a “health passport” in November, 2012 on a one-year trial basis.22 Modelled on an approach used in the Netherlands, the health passport is a small booklet that explains the 2003 FGM Act and is available in eleven languages. It is designed to be used by members of FGM-affected communities who are travelling to their countries of origin. When faced with pressure from families abroad who want FGM to be done, UK persons can use the health passport to explain that FGM is illegal under UK law, that this law protects UK girls when they travel abroad, and that the UK parent or guardian could be prosecuted upon their return to the UK if FGM is carried out abroad.
There is not yet data on the effectiveness of the health passport or response from communities who have used it when travelling, but FORWARD and other FGM advocacy groups offer the following suggestions to strengthen the health passport and make the information more accessible to communities:
Use a more neutral term than FGM. The health passport’s use of the term “female genital mutilation” rather than “female circumcision” or “female genital cutting” might alienate the target audience, causing them to ignore the message. The Netherlands uses the more neutral term “female circumcision” in their health passport, and FORWARD recommends this approach in order to reach the widest audience possible.23
Use plain language and diagrams. The health passport relies on the exact language from the 2003 FGM Act, which many people find confusing and unclear. Much of this language could be replaced with simpler language that would be more accessible to a wider audience. In addition, the Wonder Foundation has recommended the use of diagrams, as they could be more helpful to the large number of women from affected communities who may be functionally illiterate.24
19 See the NSPCC website: http://www.nspcc.org.uk/inform/resourcesforprofessionals/minorityethnic/female- genital-mutilation_wda96841.html#prevent 20 Martinson, Jane. “Female genital mutilation helpline uncovers 34 potential cases,” The Guardian, 5 September 2013. 21 Istanbul Convention, Art. 24. 22 The FGM health passport is available at https://www.gov.uk/government/policies/ending-violence-against- women-and-girls-in-the-uk/supporting-pages/female-genital-mutilation. 23 See http://www.pharos.nl/documents/doc/pp5056-verklaring-uk-2011_definitief.pdf. 24 http://www.wonderfoundation.org.uk/component/content/article/39-news/218-fgm-passport-review-wonder- response
51 Explain the health consequences of FGM. The Dutch health passport uses this approach, including a paragraph entitled “female circumcision is extremely damaging” which explains some of the major health consequences of FGM.25
Revising the UK FGM health passport with these recommendations in mind would likely make it an even more useful tool for families travelling abroad. But more importantly, dissemination of the health passport should be integrated as part of the wider range of initiatives with communities and not simply a one-off action.
4. Establish a National Advisory Board Comprised of Individuals from Affected Communities
In addition to the community-based approaches discussed above, another step worth careful consideration is the creation of a national advisory board on FGM. While community organizations are best positioned to develop educational and other strategies to discuss and prevent FGM in affected communities, a national advisory board would play a powerful liaison role between these groups and statutory agencies, health professionals, teachers, and government agencies, helping to ensure cooperation and communication among these stakeholders.
D. Competency Building Among Relevant Professionals
Health care, social care, and education professionals need much more extensive training in the detection and prevention of FGM than they have generally received thus far.26 The European Institute for Gender Equality recommends that FGM training for professionals should be mandatory and systematic, with adequate funding for such training guaranteed.27
Teachers. The European Institute for Gender Equality also points out that teachers have perhaps the most crucial role in FGM prevention because they are the professionals with the most regular, consistent, and ongoing interaction with young people.28 They are in the best position to detect warning signs that FGM may occur, they are well placed to be a resource to young people seeking help, and they may notice behavioural changes, such as going to the toilet frequently, that may indicate that FGM has occurred.29 Accordingly, comprehensive FGM training for teachers should receive great priority.
Health Professionals. Anti-FGM initiatives have had the most success in working with midwives; general practitioners (“GPs”) have been much less responsive, but research examining the response of GPs to domestic violence is illuminating.30 It demonstrates that GPs
25 See http://www.pharos.nl/documents/doc/pp5056-verklaring-uk-2011_definitief.pdf. 26 Zaidi, Knowledge of female genital mutilation among healthcare professionals. J Obstet Gynaecol. 2007: 27(2) 161-4; Simpson, Jane, Kerry Robinson, Sarah M. Creighton, & Deborah Hodes, “Female genital mutilation: the role of health professionals in prevention, assessment, and management,” BMJ 2012; 344: e1361. 27 Female Genital Mutilation in the European Union and Croatia, EIGE Report, 2013, p. 69. 28 Female Genital Mutilation in the European Union and Croatia, EIGE Report, 2013, p. 57. 29 Female Genital Mutilation in the European Union and Croatia, EIGE Report, 2013, p. 57. 30 Brown, Eleanor, “The FGM Initiative, Second Interim Report,” September 2012, p. 19.
52 have been found to increase their identification and referrals of women facing domestic violence when they know where to refer to, and when they have developed a trusting relationship with referral partners. Accordingly, the Female Genital Mutilation Initiative suggests working with GPs to strengthen these referral pathways for women and girls affected by FGM.31
Other Professionals. Training on FGM should not be limited to teachers and health professionals. It should encompass all professionals who regularly work with children or have child abuse reporting obligations, including social workers, law enforcement personnel, and others.
Cultural Sensitivity and Human Rights. Minimum standards of training in relation to FGM should be established for all professionals. This training should include guidance on navigating the tension between respect for other cultures, on the one hand, and upholding the human rights of individuals, on the other. It can be tempting for professionals who are unfamiliar or uncomfortable with FGM to ignore the practice by rationalizing that it is a cultural matter and therefore not something that requires intervention. Such professionals can gain the confidence they need to intervene appropriately when FGM is framed in terms of universal human rights. Failure to intervene in a situation where a girl is at risk of FGM would result in a human rights violation – for example, violation of the right to be free from inhuman or degrading treatment under Article 3 of both the British Human Rights Act and the European Convention on Human Rights. Such failure would also be a violation of the right to non-discrimination under the International Covenant of Civil and Political Rights and CEDAW. When professionals become adept at framing FGM as a human rights issue, they will be more able to intervene appropriately and effectively in situations involving FGM-related human rights violations.
E. Provision of Specialist Health Services to FGM Survivors
The UN General Assembly resolution on combating female genital mutilation, passed in November of 2012, calls on member states to develop social and psychological support services and care for women and girls living with FGM, and to take measures to improve their sexual and reproductive health.32 The UK has some policies that are in keeping with these objectives but should also work to expand these efforts. In particular, some specialist health services for FGM survivors currently exist but could be strengthened, and psychological support services still need to be developed.
According to the National Health Service website, currently fifteen specialist clinics across the UK offer specialist health services for FGM survivors, including deinfibulation or reversal of Type 3 FGM.33 We lack data on whether the number of clinics and their services are adequate to meet the demand for FGM specialist health services in the UK. This question should be explored through appropriate research, and plans and funding made available for expansion of
31 Brown, Eleanor. “The FGM Initiative, Second Interim Report,” September 2012, p. 19. 32 “Intensifying Global Efforts for the Elimination of Female Genital Mutilations,” Resolution of the United Nations General Assembly, 67th Session, 16 November 2012, para. 5. 33 National Health Service website, available at http://www.nhs.uk/Conditions/female-genital- mutilation/Pages/Introduction.aspx.
53 these services as needed. In addition, the UK does not currently offer any specialist health services involving reconstructive surgery in relation to the clitoris. Such procedures are available in France, and they can restore a woman’s sexual functioning and sensation in many cases.34 This should be a funding priority in the UK.
Since the specialist health services currently available to FGM survivors focus on gynaecological and maternity care, there has been comparatively less attention paid to the provision of psychological support services for women and girls who have experienced FGM. The European Institute for Gender Equality also notes that there is a lack of psychological care for FGM survivors, and particularly notes the lack of professionals skilled in handling post- traumatic stress disorder, sexual trauma, and sexual violence.35
An additional consequence of the lack of psychological care and emphasis on gynaecological/maternity care is that girls who are too young to have consulted a gynaecologist and those who are not yet married are the least likely to access specialist health services for FGM survivors. The provision of specialist health services, and signposting about them, should be expanded, particularly with a focus on ensuring that girls and young, unmarried women can find appropriate services.
F. Recommendations
1. Legal and Policy Measures
Adopt the Model FGM Act. The Model FGM Act included with this paper would greatly strengthen UK law on FGM and help to fulfil the UK’s obligations under the Istanbul Convention and other human rights instruments.
Use existing domestic legislation more effectively. The Domestic Violence, Crime and Victims Act provides a way to bring charges against parents who fail to protect their daughters from FGM. In addition, the Children Act provides protective measures that can be invoked to protect girls at risk of FGM. Prosecutors and law enforcement should be trained in the application of these laws to FGM, and they should be informed that FGM is child abuse.
Adopt a national action plan on FGM. A national action plan would coordinate all anti-FGM efforts across sectors and ensure that all stakeholders are included in planning. It would also provide a system for disseminating best practices across sectors and organizations, while allowing stakeholders to avoid duplication of effort.
2. Recommendations for Working With Communities
34 Barclay, Eliza, Surgery Restores Sexual Function In Women With Genital Mutilation, National Public Radio, 6/13/2012. Available at http://www.npr.org/blogs/health/2012/06/13/154924715/surgery-restores-sexual-function- in-women-with-genital-mutilation. 35 Female Genital Mutilation in the European Union and Croatia, EIGE Report, 2013, p. 60.
54 Continue to fund and expand the work of the Female Genital Mutilation Initiative. This initiative funds a wide range of interventions across FGM-affected communities. Through research, it has identified obstacles to ending FGM in the UK and addresses those obstacles through well-crafted intervention. It is crucial that this work receive ongoing financial support.
Continue to support and expand the FGM Telephone Helpline. Established in June 2013, the helpline fulfills the Istanbul Convention’s call to establish 24-hour telephone helplines for those affected by gender-based violence.
Improve the Health Passport. The Health Passport’s use of the term “female genital mutilation” could alienate the target audience. It should use a more neutral term, should include information on the health consequences of FGM, and should incorporate diagrams for those who cannot read.
Establish a National Advisory Board comprised of individuals from affected communities. Members of FGM-affected communities can offer essential leadership, cooperation, and facilitation of efforts against FGM. Such a board could enhance cooperation and communication between affected communities and statutory groups.
FGM specialist health services should be expanded. In particular, signposting and referral networks for currently available aftercare must be improved, and psychological support services still need to be developed.
3. Recommendations for Working With Professionals
Building Competency Among Professionals. Lack of awareness among professionals who come into contact with those affected by FGM is a key barrier to change. Professionals from every sector who may encounter cases of FGM should be trained. In particular:
Comprehensive FGM training for teachers should receive great priority. Because of their regular and consistent interaction with young people, teachers are in the best position to notice the warning signs that FGM. All teachers must be equipped to fulfil this role.
Health Professionals need training to recognize and respond to FGM. Since some health professionals, such as midwives, are more knowledgeable about FGM than others, efforts should especially target those groups, such as general practitioners, where levels of awareness and referral are low.
Training should be culturally sensitive and should respect human rights. All types of professionals who receive training on FGM will need guidance on navigating the tension between respect for other cultures, on the one hand, and upholding the human rights of individuals, on the other.
55
Written evidence submitted by the British Medical Association
Female Genital Mutilation
The British Medical Association (BMA) welcomes the opportunity to comment on the Inquiry into Female Genital Mutilation (FGM).
The BMA’s interest in FGM is primarily in raising awareness of the issue and supporting doctors who encounter girls and women who have undergone or are at risk of FGM. The BMA would refer to clinical organisations – for example, the Royal College of Obstetricians and Gynaecologists (RCOG) – to address some of the more specific practical questions raised by the Inquiry.
The Inquiry may find it helpful to consider the BMA’s main guidance on the issue – Female Genital Mutilation: Caring for patients and safeguarding children (2011). The guidance can be downloaded at: http://bma.org.uk/-/media/files/pdfs/practical%20advice%20at%20work/ethics/femalegenitalmutilation.pdf
We will be updating this guidance shortly to include the most up-to-date sources of practical advice and support for doctors, with a view to publicising the guidance in the run up to the summer when girls are most at risk of undergoing FGM. Our main membership publication BMA News has run several pieces on FGM to raise awareness and will continue to do so. BMA News is a weekly publication and has a readership of 110,000 doctors.
We hope you find this submission useful, and look forward to hearing the outcome of the Inquiry.
Yours sincerely
Professor Vivienne Nathanson Director of Professional Activities, BMA
56
Written evidence submitted by the UCL Graduate Law Society
Inquiry into Female Genital Mutilation
Executive Summary
• A major barrier to prosecution in the UK has been the identification of victims of Female Genital Mutilation (“FGM”).
• FGM is a human rights issue for all women and is not limited to child abuse, as it is currently understood in English law. A more inclusive approach to protection from FGM will help ensure identification of all potential victims.
• French practices in identifying victims of FGM cases have led to a higher number of prosecutions resulting in conviction, but give rise to certain concerns which would have to be considered and addressed before the introduction of similar, more onerous methods in the UK.
• Efforts to eradicate FGM must also involve education of affected communities in the reasons underpinning the law and the health consequences of FGM. Educated communities are less likely to practice FGM in the first place, and are also more likely to self-report deviant cases. France and Senegal offer instructive comparative examples in successful education policies.
1. Introduction – The UCL Graduate Law Society
1.1 The UCL Graduate Law Society (“UCLGLS”) is the organisation representing all graduate students in the UCL Faculty of Laws. UCLGLS membership comprises over 400 students from 69 countries, studying within 17 specialty fields of legal study.
1.2 In 2014 the UCLGLS established a project through which graduate students could substantially assist the work of Parliament through research-based submissions to parliamentary committees.
1.3 Our submissions and recommendations draw on our contributors’ research skills and particular expertise in their chosen fields of study. Further, by drawing on our members’ diverse backgrounds we offer a unique opportunity for comparative perspective on issues considered by the UK Parliament.
1.4 In 2014 Faculty Advisor to the UCLGLS pro bono project is Colm O’Cinneide, Reader in Law at UCL. Submissions of the UCLGLS are not endorsed by Mr O’Cinneide, UCL or the UCL Faculty of Laws.
2. Outline of submission
2.1 We welcome the opportunity to make a submission to the Home Affairs Committee (“the Committee”) Inquiry into the issue of Female Genital Mutilation in the UK.
57 2.2 In its inquiry the Committee will consider, inter alia, ‘[h]ow effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?’; ‘[h]ow can the systems for collecting and sharing information on FGM be improved?’; and, ‘[h]ow effective are existing efforts to raise awareness of FGM?’.
2.3 This submission will address the above questions and consider the comparative example of France where prosecution to conviction has been more common. We identify the need for an inclusive approach to FGM, not limited to its characterisation as child abuse; acknowledge the French success at identifying victims of FGM; emphasise the need for caution and concern for victims’ dignity if the UK is to introduce similar policies of mandatory medical inspections; and, acknowledge the importance of education in reducing the overall prevalence of FGM and as an aide to identification of victims.
3. Barrier to prosecution in the UK: Identification of victims
3.1 In the 28 years of specialised law criminalising FGM in the United Kingdom there has not been a single successful prosecution. Nevertheless, the NHS estimates that there are 20,000 girls under the age of 15 at risk of female genital mutilation each year, and 66,000 victims living with the consequences of the practice.1 It has been acknowledged that one of the key problems the UK has faced in protecting girls from FGM has been identifying potential and actual victims.
3.2 One aspect of the problem of identification is the UK’s treatment of FGM as an issue of child abuse. However, FGM should also be seen more broadly as a form of torture, as has been accepted by the European Court of Human Rights case of Opuz v Turkey2 and by the UN Special Rapporteur on Torture in his 2004 Report. 3 The UK thus has a positive obligation in international law to protect all women and children affected by FGM. The UK’s approach to FGM as child abuse risks marginalising potential and actual victims over the age of 16. For example, the category of FGM known as ‘infibulation’ involves the stitching of the genital area, and is often repeated throughout a woman’s life, such as stitching opened for childbirth and then ‘reinfibulated’.4 Further, a number of uncircumcised women are forced into the procedure by their husbands after marriage.5 To ensure that the UK law accounts for all potential victims of FGM, it should reflect more precisely that FGM is a form of torture, capable of affecting grown women as well as children. We acknowledge that such revision may call for Parliament to reconsider the status of consent in cases of FGM.
3.3 Another barrier to prosecution has been a lack of information from medical professionals with direct knowledge of victims of FGM. Gaining court orders for medical examinations has proved extremely difficult.6
1 http://www.nhs.uk/Conditions/female-genital-mutilation/Pages/Introduction.aspx. 2 [2009] ECHR, 33401/02. 3 “Report of the Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment,”, M. Nowak, A/HRC/7/3 (15th January 2008) (para 45-46). 4 For a detailed outline of the practice of infibulatation and reinfibulation of women see: http://www.who.int/reproductivehealth/topics/fgm/fgm_reinfibulation_central_Sudan/en/. 5 Aleinikoff., Martin., Motomura., Fullerton's., “ Immigration Law: Immigration and Citizenship” (Aspen Publishers: 2008) 57. 6 http://www.theguardian.com/law/2012/nov/13/female-genital-mutilation-prosection-uk.
58 3.4 France is considered to be among the most successful countries in the world in prosecuting FGM. To date it has successfully convicted approximately 100 people for FGM-related crimes, and has seen significant reductions in the number of reported cases.7 As we will describe in more detail below, prosecutorial approaches in France have in part resolved the dilemma of identifying victims through a system of mandatory medical checks.
4. FGM in France
A. Appropriateness of comparison
4.1 We acknowledge inherent differences between criminal procedure in the UK and France which call into question the appropriateness of direct comparison of the two systems.
4.2 In summary the key differences, relevant to the prosecution of FGM-related crimes, are as follows:
(a) French process is more inquisitorial in nature, compared to the British adversarial system;
(b) The French investigative judge (who is present in all cases dealing with serious crime) has wide powers of supervision over the police investigation;
(c) In France ‘[t]he victim enjoys a more formal status and role within the investigation and trial phases…the preamble to the Criminal Procedure Code contains a reference to the duty of the judiciary to guarantee the rights of the victim throughout the criminal process’.8
4.3 We nevertheless consider that comparison is appropriate in the circumstances. As we will show, the greater number of French prosecutions is more directly a result of the rigorous system of identifying victims than any difference in the legal systems. Further, with particular regard to our concerns for victims’ dignity specified in paragraphs 4.7-4.8, the priority given to victims’ rights in France, if anything, makes our concern for victim welfare in the UK all the more pertinent. In the absence of similar safeguards any attempt to emulate French investigative practice should be approached with special caution.
B. The French approach to prosecution of FGM-related crimes
4.4 France has no specific law against FGM. FGM-related crimes are prosecuted under much broader violent crimes, such as torture and barbarity, acts involving intended bodily harm, causing permanent infirmity or mutilation. These crimes are punished more severely when committed against a minor.9 Offenders may also be charged under Child Protection Law, the Domestic Violence Act and the Act Reforming Children’s Protective Provisions.10
7 http://www.independent.co.uk/news/world/europe/the-french-way-a-better-approach-to-fighting-fgm- 9006369.html. 8 New Zealand Law Commission, “French Criminal Procedure”, Descriptions of European Systems (2012),
59 4.5 A key factor in the success of France in identifying victims is the Professional Secrecy Law which states that medical practitioners, usually bound to protect the classified information collected from patients, must nevertheless report cases of physical abuse against children.11 French law also criminalises acts of omission. Non-assistance to a person in danger can lead to five years of imprisonment and €75,000 fine.12
4.6 The Protection Maternelle Infantile, a state-funded medical body, conducts check-ups to pregnant women and children in the first six years of their lives.13 Checks take place within the first 8 days of birth, once a month for the first six months of a child’s life, again at nine and twelve months, three times during the second year, and twice a year until the sixth year.14 Receipt of social security in France is dependent upon participation in these medical examinations. Examination includes inspection of a female child’s genitals for signs of FGM.15 The “process results in the highest rates of detection of FGM” and is one of the most significant factors in the high number of successful prosecutions.16
C. Cause for caution
4.7 Though they have been essential to resolving the dilemma of identifying victims in France, the French mandatory inspections have been controversial for the following reasons:
(a) Compulsory examinations to the age of six have been said to have resulted in some parents waiting until the child has passed that age to carry out the procedure17, thereby merely delaying the practice;
(b) Examination of young children’s genitals is extremely intrusive. It has been suggested that this in itself may be a violation of the child’s Article 8 right to private and family life under the European Convention on Human Rights18;
(c) The practice risks creating distrust of medical practitioners in affected communities. The Dutch Parliament considered whether such practices could lead to unwillingness to use medical services in times of need due to fear of prosecution, which could be even more detrimental to the already vulnerable females in affected groups.19
https://dspace.library.uvic.ca:8443/bitstream/handle/1828/2983/Thesis- 27August%202010%20DSpace.pdf?sequence=1. 11 Code Pénal: From the Breaches of Professional Secrecy, Articles 226−14. 12 Code Pénal: Non-assistance to a person in danger, Articles 223-6. 13 Bottini E, “Is juridicization of female genital mutilation an effective way of eliminating it? Western Democracies facing the violation of female integrity and dignity: illegal FGM as an integration problem” (2009) accessed at: http://www.juragentium.org/forum/mg/sunna/en/bottini.htm. 14 http://www.ameli-sante.fr/grossesse/surveillance-medicale-pour-votre-enfant.html. 15 Comission Nationale Consultative des Droits de l’Homme, “Etude et propositions sur la pratique des mutilations sexuelles feminines en France” (2004) 54 accessed at: http://www.cncdh.fr/sites/default/files/cncdh- _etude_msf.pdf. 16 http://www.ameli-sante.fr/grossesse/surveillance-medicale-pour-votre-enfant.html. 17 Costelloe n10. 18 Poldermans S., “Combating Female Genital Mutilation in Europe A Comparative Analysis of Legislative and Preventative Tools in the Netherlands, France, the United Kingdom, and Austria,” p30: http://www.stopfgm.net/wp-content/uploads/vor2013/grundlagen/SPoldermansFGMinEurope.pdf. 19 Ibid.
60 4.8 While we acknowledge the obvious temptation to introduce to the UK more rigorous medical examinations of young girls along the lines of the French approach, we urge caution before pursuing any aggressive practice of involuntary medical inspections of young girls. In particular due consideration must be given to each of the concerns raised in paragraph 4.7 and any such practice should always be conducted with the dignity of the victim as a primary concern.
5. Education and Empowerment
5.1 Education of affected communities must be a priority of any policy aimed toward the eradication of FGM. Effective education clearly has the direct effect of reducing cases of FGM, however it should also be acknowledged that an educated community is more likely to self-report incidences of FGM.
5.2 The ‘United Nations Interagency Statement on Eliminating Female Genital Mutilation’20 gives a comprehensive outline of what can be done within a community to transform the misinformed cultural beliefs and structures that reinforce FGM. It argues that eliminating FGM has to be a collective, coordinated choice. In African countries this has been achieved through public pledges, open and reflective dialogue, including intercultural dialogue among communal and religious leaders, locally and through the media. Education on the issue is a vital part of this, the provision of acceptable information on human rights, religion, and the health and reproductive implications of FGM are the foundations of this approach.
5.3 In the UK it has been acknowledged that the affected communities are often unaware of the law criminalizing FGM or the motivations behind the law. It has been argued that this is the result of the lack of translated information available to affected communities and Government reliance on small, underfunded NGOs for education.21
5.4 By comparison, in France, an aspect of the work of Protection Maternelle Infantile is FGM education for women.22 Doctors and nurses in the PMI discuss with new mothers the laws of France “in order to make the affected persons understand the reasons of this law, the reasons of our refusal of mutilations, to use all the means for prevention, all the means to explain the stakes of health, the stakes for the future of the little girls.”23 It is reported that through education young African parents in France come to accept the laws of France and refer positively to the French system.24
20 ‘United Nations Interagency Statement on Eliminating Female Genital Mutilation’ p13-17 http://www.un.org/womenwatch/daw/csw/csw52/statements_missions/Interagency_Statement_on_Eliminating_ FGM.pdf. 21 Leye E., Deblonde J., García-Añón J., ‘An Analysis of the Implementation of Laws with Regard to Female Genital Mutilation in Europe’ Crime Law Social Change (2007) 47:1–31, 23 accessed at: http://icrh.org/sites/default/files/Crime,%20Law%20and%20Social%20Change%20january%202007%20revisio n.doc.pdf. 22 Guine A., Javier F.,“Engendering Redistribution, Recognition and Representation: The Case of FGM in the UK and France.” Politics and Society, Sept 2007, 35(3), 477-519, 501. 23 Groupe pour l’Abolition des Mutilations Génitales Féminines (GAMS), “Journée Technique d’Information sur les Mutilations Génitales Féminines (Actes)” (Paris: GAMS, February 15, 1996). 24 E. Leye, M. de Bruyn, and S. Meuwese, Proceedings of the Expert Meeting onFemale Genital Mutilation, Ghent, Belgium, November 5-7, 1998.
61 5.5 Senegal is one of the leading examples of a country that has made major progress in reducing FGM through an educational approach. According to a report by EuropeAid, a branch of the European Commission, “Senegal is close to becoming the first country in the world to declare total abandonment of FGM...Nearly four of the five thousand practicing communities have announced that they will abandon the practice”.25 Studies have shown that 25% of girls and women aged 15-19 had been victims of FGM, a significant reduction from the 31 % of women aged 45-49.26
5.6 Following the UN’s recommendations, local Senegalese NGOs like Tostan, have actively helped local communities abandon FGM. Tostan, an NGO based in Dakar, runs a Community Empowerment Program, providing a three-year non-formal programme to villages, focusing on education on human rights matters, including FGM. The programme is designed to facilitate dialogue within and between communities and provides training sessions to encourage social change at grass-roots level. As part of this educational programme, risks associated with FGM are explained and discussed with communities.27 In addition, the NGO ENDA-GRAF raises public awareness of FGM through theatre productions in the Kolda, Thies, Rufisque and Dakar regions and through seminars, discussion groups and radio programs on the topic.28
5.7 We recommend greater allocation of resources to prevention and empowerment domestically. The examples of France and Senegal offer concrete models for implementation of educational policies and offer statistical support for the conclusion that investment in education leads to reduction in instances of FGM in a way that is perceived positively by affected communities. It is also likely that a more informed community will be more inclined to self-report cases, in turn contributing to prosecution success.
6. Conclusion
6.1 In light of the above we remain concerned that adoption of the French approaches to identification of victims of FGM will not strike the appropriate balance between the pursuit of prosecution and the needs of victims. We stress that the dignity and particular needs of all victims should always be a primary concern. To this end, a policy focused equally in education and prosecution has been shown to be effective at reducing incidence of FGM in France and in Senegal and is likely in itself to contribute to resolving the dilemma of identification of victims.
Sadiyah Ahmed: Lead Author29 UCL Graduate Law Society 12 February 2014
25 http://ec.europa.eu/europeaid/news/12-03-07_fgm_en.htm. 26 Ibid. 27 http://www.soschildrensvillages.org.uk/news/archive/2013/03/abandoning-fgm-and-child-marriage-in- senegal-and-africa. 28 http://www.asylumlaw.org/docs/senegal/usdos01_fgm_Senegal.pdf at.2 29 With the assistance and research of Adriana Lozjanin, Conor Opdebeeck Wilson, Alexandra Hearne, Oliver Cheung and Andrew White.
62 Written evidence submitted by Movement for Justice
Female Genital Mutilation
Every woman who is escaping FGM, protecting her daughters from FGM or facing persecution because she refuses to act as a ‘cutter’ must be AUTOMATICALLY granted asylum if she comes to Britain.
Reverse the ‘Burden of Proof’ in asylum cases. The burden of proof must be on the Home Office, not on the asylum seekers.
1. Female Genital Mutilation (FGM) is torture and child abuse. It is a cruel and extreme form of the subjugation of women through the direct suppression and control of their sexuality. In the countries where it has traditionally been practised it has deep roots in the subordination of women by patriarchal societies. Britain has publicly supported international declarations against FGM, a position in line with its support for declarations on the rights of women and children. It is the Movement for Justice’s submission that the Government’s fine words will have no meaning until and unless Britain’s actions are strengthening and not undermining the women who can actually end FGM - the women who are resisting the ‘cutters’ by any means necessary.
The fight to end FGM is international. 2. FGM is being questioned by growing numbers of women in societies where it has been long established, and that is happening because those countries are undergoing rapid change. They are increasingly integrated into the global economy and affected by international social developments through trade and investment, communications, urbanisation, education and migration. Africa and the other regions with a tradition of FGM are more exploited by the great capitalist powers and more integrated into the world market than they were under colonial rule. Their young people are increasingly connected socially and culturally with the rest of the world. These changes are inevitably weakening the traditional social structures and systems of authority in which FGM plays a central part. More and more women in those countries (and in the expatriate communities in Britain and elsewhere) no longer see FGM as inevitable and are trying to avoid it for themselves or their daughters; some, a growing number, are challenging it directly or resisting it physically in ways that would have been unimaginable even a generation ago.
3. Every act of resistance is a challenge to the authority of community or tribal elders and conservative religious leaders; every successful act of resistance is a blow that encourages more resistance. The traditional elders and institutions become more desperate to hold on to FGM and women who oppose them face threats, the kidnapping of their daughters and torture. In some cases ‘cutting’ is directly linked to the rise of anti-gay scapegoating and bigotry: EB, a Movement for Justice member and lesbian from Kenya was born into a family that had rejected FGM; she was cut when her parents were alarmed by the evidence of her sexuality while her sisters were spared this fate. In some countries like Kurdistan social and political turmoil seems to be leading to a resurgence of FGM.
4. However the biggest obstacle for women who oppose FGM is the collusion of the governments and the police etc. with its continuation, even when it is formally prohibited by law. The governments in most of the countries concerned are themselves threatened by the effects of rapid economic and social change, even as they act as promoters and agents of change – as in many African countries where AIDS is creating an imbalance between young and old, agribusiness is dispossessing peasant communities and young people are reaching working age faster than economic growth can create new jobs. In order to maintain control in
63 such fragile and explosive situations the governments generally rely on the co-operation and support of the traditional authorities of tribe, clan, religion etc. As a result they are unwilling to challenge FGM where it is part of traditional systems of authority, and unwilling to protect the women who oppose it.
Support the women who are standing against FGM 5. There are very many women, especially from Africa, who are living in Britain because they are resisting FGM. Some have managed to avoid FGM but have had to leave their countries before it is forced on them (often in connection with an arranged marriage); probably most are here to protect their daughters; a number are trained hereditary cutters who were tortured because they refused to carry on the practice. What they all have in common is that when they claim asylum they are routinely disbelieved and their claims are generally rejected by the Home Office and immigration tribunals. Many have been deported; many are living under the threat of deportation.
6. Maimuna Jawo, 43, from the Gambia and Josephine K, 63, from Sierra Leone, members of the Movement for Justice, are both hereditary cutters trained by their mothers to continue the practice. They were due to inherit a position of prestige and authority within their communities but refused to continue cutting, recognising it as torture. They both suffered abuse, violence and torture because of the stand they took, and both had to make the difficult choice to flee rather than surrender to the demands of the elders. For Maimuna that has meant separation from her children. For Josephine it meant leaving the job she loved as head-teacher of the local school. Both claimed asylum in Britain, and instead of receiving the protection they deserve both these brave women have received disbelief, calumny, and rejection after rejection from the Home Office and immigration tribunals. Both have endured months of incarceration in Yarl’s Wood detention centre and only Josephine’s determined refusal to get on a plane at Heathrow saved her from renewed torture in Sierra Leone.
7. Another Movement for Justice member, Amie B, also from the Gambia, sought asylum in Britain to protect her daughter, now 6, from FGM. Amie’s daughter was born in Britain. When she was 3-years old Amie returned to the Gambia with her husband, an accountant with a world-renowned company, but they faced mounting pressure to have their daughter cut and knew that the decision could be taken out of their hands. After eighteen months they made the hard choice that, for their daughter’s sake, Amie should bring her to Britain before the next round of cutting, leaving her husband and son in the Gambia. Amie claimed asylum immediately but, after waiting for more than a year, she got a refusal from the Home Office in January. The Home Office argued that, as educated people and as the mother and father, Amie and her husband could easily prevent their daughter being cut.
8. This wilfully ignorant argument flies directly in the face of the reality of the situation in Gambian society – and goes directly against a major ‘country guidance’ case heard in the Upper Tribunal in November 2012 - K and others (FGM) The Gambia CG [2013] UKUT 62(IAC). The Upper Tribunal accepted the evidence of a series of expert witnesses with extensive knowledge of Gambian society and explicitly rejected a Home Office argument that was identical to the one it used in Amie’s refusal – that educated parents who opposed FGM would have the power to prevent the extended family and community elders forcibly cutting their daughter. The Home Office is cynically forcing asylum seekers to fight near-identical cases individual-by-individual, knowing that most often their isolation, lack of resources, detention on ‘Fast Track’ in Yarl’s Wood or poor representation by their lawyers will allow it to deport them to the risks of FGM.
9. The betrayal of Maimuna, Josephine and Amie represents the Home Office’s general practice in FGM asylum cases. On paper the Home Office recognises that women and girls at risk of FGM qualify for protection. In practice the immigration & asylum system makes nonsense of that principle with decisions that tell women they are not at risk, using
64 arguments that the women and all the country experts know to be untrue: that parents are in a position to stop a girl being cut; that you could avoid FGM by moving to another area; that FGM is not a problem in cities; that you could get police protection if you or your daughter is in danger of ‘cutting’; that if you are an adult you are ‘too old’ to be cut; that if you are educated you can easily prevent your daughters being cut.
Where we stand in the conflict 10. The Movement for Justice stands unequivocally with the women around the world who are resisting the cutters. The decisions the Home Office and Tribunals are making to refuse women seeking protection undermine all the women and girls who are trying to resist FGM in the countries where it is traditionally prevalent (and in Britain too). When Britain refuses FGM-related asylum claims or deports women who have escaped or resisted the cutters it discourages and disheartens many more women who want to see an end to this torture. It is telling women that they can’t escape the cutters or win change and telling the governments of those countries that they can ignore Britain’s denunciations of FGM. In the conflict between the upholders of FGM and the women who are resisting it the actions of British immigration system are tipping the balance of forces AGAINST the opponents of FGM.
11. Maimuna Jawo of the Movement for Justice has become this country’s leading fighter against FGM because she refuses to be silent about the British Government’s hypocrisy, its racist abuse of the rights of asylum seekers and immigrants, and its complicity in maintaining FGM, and other forms of oppression and persecution. She is building a movement to fight injustice and racism and win equality. She is speaking out at public forums, in colleges and on demonstrations. Last year she was interviewed by the TV journalist Sue Lloyd-Roberts, who has done so much to expose FGM, for a report first broadcast on Newsnight report on 3rd September 2013. Maimuna spoke about her history in the Gambia and the injustice of her treatment in Britain. Lloyd-Roberts travelled to Maimuna’s village in the Gambia, spoke to her family and interviewed cutters and Gambian anti-FGM campaigners. An extended version of the report was broadcast on the BBC news channel’s Our World (under the title of Dropping the Knife) and on CNN. It was watched across Africa, from the Gambia to Tanzania.
12. Maimuna was flooded with messages of support from women in Africa who were inspired and encouraged by her stand. Many expressed their alarm and concern when they heard on the TV report that she is still under threat of deportation; they told her that they were praying for her not to come back. Women from Maimuna’s village have told they pray for her to stay in Britain because her absence means their daughters are safe from cutting. Maimuna has done more to fight FGM internationally than any of the Government’s empty words – but she has not been granted asylum and still faces the possibility of deportation. Her deportation would be a blow to every woman who has been inspired by her courage and would have the cutters rejoicing.
End the Miscarriage of Justice. Reverse the Burden of Proof in Asylum Cases. 13. Britain must ensure that from now on it weights the scales in favour of the women resisting FGM in Africa and the other regions where it is practised, and not against them. The single most effective and necessary change is for every woman who is escaping FGM, protecting her daughters from FGM or facing persecution because she refuses to act as cutter to be automatically guaranteed protection and support if she comes to Britain – and not put through hell by the Home Office, disbelieved, detained, left destitute or deported. That will strengthen the position of every woman in any of those countries who is trying to avoid or resist FGM and send a clear signal to their governments that Britain is seriously committed to its eradication.
65 14. To make the necessary change to practice requires a fundamental change in the asylum system. At present, like all asylum seekers, the women claiming asylum from FGM are expected to prove a negative – prove that they are not lying. That means there is an assumption that they are lying. The ‘burden of proof’ in asylum cases is on the asylum seeker, while the Home Office does not have to prove anything. In any other area of law the burden of proof is laid on those in authority. In criminal law the prosecutors have to prove the defendant guilty beyond all reasonable doubt; if a worker brings a discrimination claim to an employment tribunal the employer has to prove that he or she has not discriminated. It may not work perfectly, but the principle in these situations is that justice can only be achieved if the legal system ‘levels the playing field’ - mitigating the inequalities in wealth and power between the state and the citizen, the prosecutor and prosecuted, the employer and the worker etc. This principle has been won through historic struggles. Asylum law is the only area where this principle is reversed. Asylum seekers are uniquely discriminated against by the legal system, with the result that every asylum case is a miscarriage of justice, even for those who eventually ‘win’.
15. Justice for women resisting FGM, as for all those seeking protection from persecution, requires that the burden of proof in asylum cases must be on the Home Office, not on the asylum claimant. That fundamental and essential change is the most significant action Britain can take towards ending the torture and abuse of FGM.
66 Written evidence submitted by Vera Baird QC, Police and Crime Commissioner for Northumbria
Thank you for the opportunity to provide evidence to your committee about Female Genital Mutilation and our experiences in Northumbria. It is only right and just that FGM is recognised internationally as a violation of human rights and I am very encouraged to see that the Home Affairs Committee is fully committed to understanding the barriers to disclosure and prosecution, to help reduce this violent and abhorrent crime and bring those responsible to justice.
As requested I have structured our response around your key lines of enquiry. This response has been shaped by the views of my PCC Gender Advisory Group and reflects the intentions and a key priority area in the north east regional Violence against Women and Girls (VAWG) Strategy. As with all priorities in the strategy the aim is simple – to make help more available so whenever or wherever a victim-survivor seeks help, there is someone with the training needed to cope calmly with any disclosure and engage her with support services and a route to safety.
Existing legislative framework and the barriers to effective prosecution
The 2003 Female Genital Mutilation Act is an extremely important addition to the statute book. The problem lies with implementation of the legislation rather than the legislation itself. For too long we have been far too passive about the issue of FGM, many see it as a deeply entrenched cultural tradition, overlooking the fact it is actually a serious crime and form of child sexual abuse.
The lack of prosecutions of FGM since 2003 has been mentioned over 45 times in parliament to no avail. Women need to see the law being enforced against FGM to help build their confidence to report incidents and also stop this terrible abuse for future generations.
Prosecution relies heavily on victims disclosing what has happened to them or is about to happen to them and as most victims of FGM have grown up in a culture that makes them believe that this act is a good thing and makes them clean they are unlikely to come forward and disclose. We need to be vigilant and encourage schools to ask the appropriate questions if young girls do not attend school for some time or display behaviour that indicates they are in pain or discomfort.
Further barriers to prosecution appear to be the gaps in or lack of multi-agency co-operation. It would appear that different statutory agencies are not appropriately speaking to each other or logging potential cases. Julie Bindel wrote in ‘An unpunished crime – the lack of prosecutions for female genital mutilation in the UK’ that around 170,000 women and girls in the UK had undergone FGM. This is a shocking statistic as policies and legislation have been in place since the 1980s, strengthened by the private members bill in 2003.
The current position in the UK of no prosecutions for FGM cannot continue, nor can the brutal harm women and girls are subject to through FGM. I will watch closely and learn from the ongoing case in this country where a prosecution for FGM is expected to go ahead in the very near future.
Those at most risk in the UK and the barriers to identification and intervention
Those most at risk in the UK appear to be from the Horn of Africa such as Somalia and parts of north east and west Africa. The practice of FGM can be fund among all religious, ethnic and cultural groups and across all socioeconomic classes.
The main barrier to identification is resistance on so called cultural grounds on the parts of families who wish to practice this act, and unease from others about broaching the subject. The barrier to
67 intervention is that there is a lack of understanding about the legislation surrounding FGM and the support services available – something I wish to address through my VAWG Strategy.
The role of the Police and multi-agency co-operation
Multi-agency co-operation needs to be enhanced across the board and strengthened to include seamless pathways between victim identification, referral, support and the criminal justice system. There are opportunities to have more hard hitting, joined up campaigns both at a national and local level where agencies have already well developed resources which can be shared and utilised widely.
All key agencies particularly those that have a specialist knowledge in this area have a role to play in ensuring the safety of those girls at risk of FGM, from the frontline health professional spotting the signs of violence, Local Safeguarding Children’s Boards, to the police gathering the right evidence and the Crown Prosecution Service considering how they can best support the victim to ensure a successful prosecution. Working together as agencies and together with our local communities is the only way we will be able to stop this crime and bring those responsible to justice.
Very specifically, the role of the police should be to employ greater use of intelligence-led police operations and surveillance, particularly against "cutters". To support this sentencing guidelines could offer significantly reduced sentences for former cutters or parents who co-operate with the police and relevant authorities.
In addition I would suggest that there should be a change in the law to require all professionals who came across examples of FGM (likely to be doctors, midwives, nurses who see physical evidence or anyone who gets a disclosure from a victim) to report it. FGM is practised by particular communities and if it is present in one woman there it is likely to be endemic and a threat to future women and girls and we must identify its prevalence enabling agencies’ to target intervention work.
I know collecting evidence and information for this form of abuse can be difficult for a variety of reasons, one being that child victims would have to give evidence against their family potentially criminalising parents and older brothers and sisters which is a very difficult situation. That is why my role as Police and Crime Commissioner and the role of the police is essential in ensuring victims receive the correct support, that action is taken, and those people who commit the crime are dealt with appropriately.
Systems for collecting and sharing information on FGM
To put an end to this injustice that has been carried out for thousands of years it will take a huge change of mentality. FGM is a deeply rooted tradition that cannot be stopped by legislation but by the people and communities carrying this out and standing by while it is carried out.
There is a need for a multi-agency system which allows all agencies access to the same information about potential cases, allowing agencies including health to work together to tackle individual cases and collect and share sufficient evidence to proceed with successful prosecutions and prevention work in areas where there is a concern that the practice continues.
Raising awareness of FGM
There are many ways in which we can raise awareness of FGM and help to reduce this criminal act across the UK:
68 • Education in schools – age appropriate discussions in schools and within girl’s projects. We know that girls between 5-8 years old are at most risk and therefore it is important that they understand how to keep their body safe. • Reaching mothers – women who have experienced FGM themselves need support to understand what they have been through as well as support to safeguard their own daughters. • Religious establishments – FGM is not a religious act so the more faith leaders are encouraged and supported to spread this message the better. • Working with new arrivals to the country – working in a really proactive and positive way delivering the message that the practice of FGM is illegal in the UK and any abuse of girls is intolerable.
To underpin this awareness raising work it is essential to develop accessible and culturally appropriate material, toolkits for discussion with adults and children. This is not a quick fix but something that has to be seen as a more long-term education and awareness programme. The national zero tolerance day for FGM is a good start but something that must be built upon as a first step to awareness raising, a more detailed programme of activity is sorely needed.
Training for frontline staff working with communities across the board is key to ensuring early signs of FGM are recognised and the most appropriate support, intervention and prosecution where there is robust evidence. Compulsory training for doctors, midwives, receptionists at clinics and health teams for them to report cases of FGM to health authorities and the police should be carried out.
We have good examples of frontline training in Northumbria, for example the Shine Newcastle project that looks to offer women free and confidential advice about a range of issues related to sexual health. Honour based violence and FGM training is rolled out to all new police recruits, community support officers, call handlers and investigators with more in-depth training provided to our protecting vulnerable people unit. The training provides officers with information about legislation, support services and appropriate responses.
I was very pleased to find out recently that midwives in one part of Northumbria are trained to identify signs of FGM on expectant mothers and have systems in place to report the birth of a baby girl to social services where the mother has been subject to this act as due to the mothers history the baby is now at risk of FGM.
Support services for women and girls
Available support services for women and girls who have suffered FGM should be improved to provide a one stop shop where women can go for safety and who may fear their younger siblings, relatives or friends are going to be subject to FGM. It is essential to provide safe places for girls to go who are fleeing this violence or who report it and are fearful to return home.
Resourcing education and awareness campaigns and providing the necessary support to keep victims safe from harm can be great but by working together with others, sharing resources, materials, working more efficiently to identify victims of FGM and provide the support needed can lead to more effective and leaner ways of working.
Learning what works well across the country in terms of raising awareness of FGM, providing appropriate support services for the victim and providing opportunities for people to confidentially report this crime whether happening to them or to someone they know is essential to ending this violence for the current generation and generations to come.
69 Written evidence submitted by the Hawa Trust
INTRODUCTION
Hawa Trust welcomes the Select Committee’s initiatives to combat Female Genital Mutilations (FGM). Those who engage in such practice must be prosecuted. Prosecutions have occurred in France and other mainland European countries, but nothing has so far happened in the whole of the UK. We hope that this consultation will have significant effects in practice. There is obviously much to be done. I hope the following presentation will help in this regard.
Professional and personal experience of - FGM I involved in the fight against FGM for many reasons, I became a victim 0f FGM while I was just 13 years old in Sierra Leone. I remembered when my aunty took me to the Northern Province of Sierra Leone in order to undergo the FGM ceremony.
In the morning hours, I was taken to the “Bondo Bush”, there I saw lots of women dancing and singing, while the cutting was going. When my turn reaches I was put on the floor in order to do the cutting.
The procedure is usually carried out in secret and leaves victims in agony, survivors can be left with lifelong physical problems and psychological trauma, and some even lose their lives. The thought of the operation, As a victim of female genital mutilation (FGM), I am appealing to girls who feel they are at risk should come forward for help.
In Sierra Leone where I comes form, around 94 per cent of women have undergone FGM between the ages of 15 and 49 have been cut. (See my interview on Channel 4 news at http://www.channel4.com/news/first-fgm- helpline-to-protect-uk-women-and-girls).
I developed more interest in FGM while completing my MA degree in Social Work at the Anglia Ruskin University. I realised that apart from the physical effects of FGM, there were several psycho-social factors which are not really noticed but it can resulted in life time impacts in a form of depression, Post Traumatic Stress Disorder, and similar challenges. However, such challenges were not being addressed either by the public services or community organisations.
There needs to be a cultural understanding of the FGM abuse so as to prevent its occurrence and empower the victims.
Hawa Trust worked to create awareness of FGM in Hackney and it is the only Trust presently working on this issue to bring awareness among Africans, Asian women and girls in Hackney.
70 I have attended several meetings that include Hackney Safe Guarding Board, the House of Parliament, intercollegiate FGM Symposium, CVSE meeting and RCM. We also contributed in establishing a helpline for the NSPCCA.
However, what have not been addressed by several organisations are geographical factors in the continuation of FGM. FGM did not start in the UK; the practice came here from the countries of origins of those practicing it. Addressing issues only in the UK is not enough.
As I state below there are needs to be action in Africa, Latin America and the Middle East. There are arrangements with foreign countries in terms of legal positions but there is no programme which supports UK-based organisation to work both in the UK and in Africa. Organisations like ours can understand what is happening here and then trace the patterns of FGM which happen in Africa. While efforts are to be made Some parents in the Diaspora took their children during the holidays to undergo FGM play a significant role in undermining the FGM message in Africa.
GENDER VIOLENCE AND CULTURE IN SIERRA LEONE SEXUAL VIOLENCE
“Sande and Bondo” Secret societies: Female genital mutilation (FGM) which is widely practiced on women and girls in Sierra Leone is one of the activities of “Sande and Bundo” secret societies. FGM is generally practice by all classes, including the educated elite. Secret Societies like the Sande and Bundo where girls are forced to undergo certain rituals, such as puberty rites are also widely practiced in Sierra Leone both Christians and Muslims with the exception of the Krios who live in the western area. The girls of the secret societies are taught to be submissive to their husbands. Traditional dances and annual feast are part of the rituals. It is reported that the 85 percent of women and girls in Sierra Leone are members of this secret societies. Female genital mutilation is a cultural practice without religious foundation or justification despite the misconception and misinterpretation to the contrary on the part of the victims and perpetrators. The ignorance of many women about religious teachings and interpretations has led them to believe that their status is unequal to that of men and that their subordination is a dictate of God.
This believed is so deeply rooted, especially among traditional societies, that women accept cruel and degrading treatment as part of their obligation. Human societies that are strongly marked by a patriarchal system are also characterized by various forms of violence against women to control their sexuality and fertility. Female genital mutilation is an extreme form of violence, injurious to millions of women and girl children.
71 According to the estimate of the World Health Organization, over 100 million women are affected by the practice.
The practice is usually performed, under very unhygienic conditions, by untrained elderly women – Ouddo in Somalia, Daya in Egypt, Khafedha in Sudan, Sunnah in Mali, Bondo or Sande in Sierra Leone. Using razor blades, pieces of glass, or knives, these same women, in most countries, are traditional birth attendants and traditional healers.
In Mail, Nigeria, Guinea, Gambia and Sierra Leone, practitioners perform FGM as an income-generating activity. In Sudan, Somalia, Djibouti and Nigeria, some mothers are known to take their daughters to clinic to make sure that the operation is performed under medical supervision.
Old grandmothers or aunts operate on the girls. In some countries likes Indonesia and Malaysia, small incisions are made in the prepuce of the clitoris without totally removing it. Virginity is a strong reason cited by mothers and grandmothers for preserving the practice of FGM/C.
The young uncircumcised girl is still considered today as a second-class citizen, impure, a bilekoro, according to a typical expression in Mali and Guinea such a young girl can neither married nor even be allowed to prepare the family meal until she agrees to be circumcised.
The practice is inculcated in the minds of girls by family members and peer groups throughout their socializing process. In Sierra Leone, FGM forms a part of the initiation ceremony of womanhood. After the physical operation the girls undergo training on how to be good wives, mothers, and members of their society. Dr Olayinka Koso- Thomas in her book, the circumcision of woman describes the ceremony of graduation.
Geographical distribution of female genital mutilation; FGM is said to have been practiced worldwide at one time in history for various reasons all related to women’s sexuality. At present its prevalence is largely observed in Africa.
According to reports presented by Dr Koso-Thomas, in different seminars, the practice exists in the following countries. Excision (Clitoridectomy) Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote D Ivory, Djibouti, Egypt, Ethiopia, Gambia, Ghana, Guinea, Guinea Bissau, Kenya, Liberia, Mali, Mauritania, Niger (Small part of the country), Nigeria, Senegal, Sierra Leone, Sudan, Tanzania, Togo, Uganda and Yemen. Circumcision (Sunnah) The above mentioned countries plus Australia, Bahrain, parts of India, Indonesia, Malaysia, the United Arab Emirates and Yemen. Infibulations; Djibouti, Egypt (Nubians), Ethiopia Mail (among a few ethnic groups) Somalia and Sudan. FGM is also reported to exist in Europe among the immigrant populations in UK, Finland, France, Italy, Netherland, Sweden, and the United States.
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How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
Lack of effective and practical collaboration among professionals, including pre-schools, social workers, and teachers
Lack of awareness of the legislation among professionals, This is done well by grassroots charities But lack of funding of these charities
Lack of support for victims who may want to report their parents
Failure to address FGM abroad especially in Africa; Parents take their children abroad to undergo this practice (FGM)
Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention? The main groups that are at risk of FGM in the UK are mainly BME communities especially women and girls from sub-Saharan African backgrounds. In Sierra Leone, West Africa, the main communities affected are women and girls from the provincial tribes. These include girls as young as 5 years and women. There are several barriers to identification and intervention. In terms of identification, it is difficult to identify women and girls at risk in the UK. This is because In terms of identification of those most at risk in Sierra Leone
In terms of intervention, there are several barriers to intervention for women and girls at risk in the UK. This is because
In terms of intervention of those most at risk in Sierra Leone, there are many barriers. These include, Cultural taboos relating to the family much of the abuse being perpetrated goes unreported. FGM problem is not discussed it is a big taboo in African community. Young girls are suffering unnecessarily many bleed to death or are infected with HIV, Hepatitis and other diseases; there is much ignorance about the issue among African communities. Many Africans feel FGM is out culture and we must support it. Engage with people from Africa, Middle East and Asia on practical strategies to combat the FGM abuse. Support initiatives like help line, refuge, asylum support, etc for victims. In Sierra Leone, FGM is called Bondo society is very influential. The government is afraid to oppose it; it tried once to enact a law to ban FGM, but later withdrew it.
73 The Bondo society provides votes for politicians, children as young as 3 are subjected to FGM abuse. To stop FGM here we need to also raise awareness in Sub- era- African.
Marriage and FGM: In most African and Middle Eastern communities Practising FGM, the main justifications concentrate on morality, virginity, honour and marriage, and sexual control, FGM is expected to fulfil and Maintain these virtues. For most African women as well as other Third World women marriage is not an option but a must for survival. Marriage and reproduction are the only guarantee for women to gain economic security and social status.
Infertility is one of the worst fates that a woman can face in her life in these communities. Marriage ensures a woman with old age pension or security as well as respect in the society. A woman without children or an unmarried woman will have a very difficult life and a devastated old age, especially ones without any support from their relatives or community.
The whole practice of FGM is the base for marriage. Without undergoing FGM, a woman is denied the right of marriage, in most cases also the denial of receiving bride price. An unmarried woman is an outcast in the society.
In Africa marriage does not come easily without its sacrifices. Virginity must be maintained at the time of marriage and the lack of it has damaging social consequences to the individual as well as to the parents.
Virginity is the base for marriage ability and it also enforces the prohibitions of sexual relationships outside marriage. Virginity is also considered as a base for a family’s honour. A girl is expected to bring honour to her family through the preservation of her virginity. This is where FGM comes as a means of ensuring virginity. It is also believed that virginity of a woman ensures the fatherhood of the husband.
Another misconception is that women are presumed to be weak in areas of emotion and, therefore, must be controlled. In other words, women are unable to control their sexuality. That is why it is believed that uncircumcised girls are assumed to run wild, or are considered of loose moral, bringing shame to their parents.
74 FGM is expected to play that role by reducing the girl’s sexual desire and prevent sexual experience before marriage. The reduced desire even during the marriage is expected to ensure faithfulness of the woman to her husband.
It is believed that FGM controls women’s sexuality effectively. FGM may reduce the feelings but it cannot reduce the desire and, in addition, it does not guarantee chastity. It does not guarantee the morality of women, as shown by the fact that FGM practising countries have relatively high numbers of prostitutes.
In addition, FGM has nothing to do with moral behaviour which comes basically from proper moral education and the individual’s intended behaviour.
Gender identity is also given as a reason for the practice of FGM. It is practiced to clearly distinguish the sex of an individual based on the belief that the foreskin of a boy makes him female and the clitoris of the female makes her a male.
So in FGM practising countries the removal of the clitoris, which is believed to be male parts, makes a woman feminine. In addition, clitoris is considered to be ugly on a girl and must be removed to eliminate any indications of maleness. Some go even to the extreme by priding themselves on the degree of mutilation. According to one Sudanese woman, “In some countries they only cut out the clitoris, but here we do it properly. We scrape our girls clean. If it is properly done, nothing is left, other than a scar. Everything has to be cut away.”
The clitoris and labia, considered to be the masculine parts, are seen as dangerous and poisonous organs and must be removed for health reasons. It is believed that they will kill a baby during birth and will also cause trouble to the man during intercourse.
Similar attitudes and misconceptions include that leaving a girl uncircumcised endangers both her husband and her baby; if the baby’s head touches the uncut clitoris during birth, the baby will be born hydrocephalic (excess cranial fluid). The milk of the mother will become poisonous. If a man’s penis touches a woman’s clitoris, he will become impotent. The misconceptions are listless, but one can easily see that all these justifications are scientifically refutable. Ignorance and the cover of tradition ensure its survival.
75 It is further believed that the removal of the clitoris and labia contribute to the cleanliness and beauty of women because an unmotivated woman is considered dirty and polluted. This is one reason why uncircumcised women are ostracized within their own families and communities. The absence or removal of the clitoris keeps the vagina clean and makes vaginal intercourse more desirable than clitoris.
What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi- agency co-operation be improved?
Local authorities, under section 10 of the Children Act 2004, have a responsibility to promote inter-agency cooperation to improve the welfare of children. The multi-agency guidelines specify that Local Safeguarding boards are responsible for ensuring inter- and multi-agency training in FGM. Moreover,
Social Service to implement a social work team.
Engagement of Police with communities affected by FGM.
Health; Maternity and child health data sets is a national database which links maternal health and child health records, ensuring that information from maternity is shared with child health professionals, and strengthening data recording to identify FGM or the risk of FGM.
How can the systems for collecting and sharing information on FGM be improved?
Funding is lacking for small grassroots organisations. Moreover, it seems that these top tier organisations tend to exploit the smaller organisations by gathering information and data from them which they then use to apply for large funding.
There needs to be special funding streams which target smaller organisations which have local knowledge and which deliver vital services at the grassroots level and for those communities which slip through the public servicers and those provided by top tier organisations.
How effective are existing efforts to raise awareness of FGM? I have made presentations at various for on FGM. I have worked with Dr Comfort Momoh, MBE, who is the FGM National Coordinator, and head of the African Well Women’s Clinic Guy’s & St. Thomas’s Hospital. I made a PowerPoint presentation on the challenges of combating FGM in the UK.
FGM has caused severe damage and trauma to young lives, yet it remains a taboo and a misunderstood subject.
76 It is against this background that Hawa Trust recently organizing a public awareness-raising event to provide deeper understanding on FGM and support young women who are vulnerable to FGM. This events took place on Friday 6th December 2013 at the Kingsmead Community Centre, 9a Kingsmead Road, Homerton Road, Hackney, London E9 5QG.
The Keynote Address was delivered by Dr. Comfort Momoh, MBE (FGM/Public Health Specialist; FGM National Coordinator, African Well Women’s Clinic, Guy’s & St. Thomas’s Hospital). A statement was also made by Ms Debbie Ariyo, OBE, Founder/Executive Director, and AFRUCA – Africans United against Child Abuse.
Dr. Momoh’s PowerPoint presentation was a shock to the women attendees as they did not realize that FGM had terrible physical and psychological effects. Some of the women who attended reports that they were experiencing forms of trauma and were invited to attend the African Well Women’s Clinic at Guy’s & St. Thomas’s Hospital. This was the first event of its kind in Hackney. This is a significant milestone for Hawa Trust and for the communities we are working with.
Sensitization and awareness rising of FGM and HIV among local communities
Education activities at schools, especially towards the long holidays; Dropping leaflets and other promotional materials;
Drop-in services to inform girls and young women about the risks and dangers of FGM;
Parent information evenings to discuss with them about the dangers of the practice;
Lobbying local council and other authorities to initiate policies and guidelines to prevent and deal with FGM;
Engaging with community leaders – like pastors, imams, youth leaders, and heads of community organisations – to involve them in FGM prevention;
Raising funds to support victims and their parents to manage and overcome the effects of FGM;
Provide alternative summer activities for young people
How can the available support and services be improved for women and girls in the UK who have suffered FGM?
Creation of an FGM team just as currently there is a domestic violence team, or children looked after team
77 There is a need for a distinction between the health focus of FGM and the cultural factors. There should be efforts to show that tackling FGM has nothing to do with African culture
Work in place of origins of FGM – in Africa What is the UK doing in those countries where FGM is done abroad in the African continent?
Hawa Trust is willing to provide additional specialist information on FGM in Sierra Leone and West African countries on the need to negate with sierra Leoneans and other Africans so that we can address
Declaration of interests Hawa Trust declares that in making this presentation we received no support from any organisation, we have no financial relationships with any organisations that might have an interest in this particular presentation, and have no other relationships or activities that could appear to have influenced the contents of this particular presentation.
Mrs Hawa D. Sesay, Executive Director, Hawa Trust (Ltd), Website: www.hawatrust.org.uk
References:
Dr Comfort Momoh, MBE FGM National Coordinator, and head of the African Well Women’s Clinic Guy’s and St Thomas’s Hospital
Dr Olayinaka Koso- Thomas Campaigning against the practice for nearly three decades, her book entitled” circumcision of women, strategy for eradication of female Genital Mutilation in Sierra Leone (1987).
UN Children’s Funds (UNICEF) reported 94 percent of women in Sierra Leone had undergone FGM/C http;//www.channel4.com/news/first-fgm helpline-to protect-uk- women- and girl
Local Authorities under Section 10 Children Act 2004.
Sierra Leone’s 2007 Childers Right law Forbids
World Health Organization (WHO) Khartoum Seminar 1978
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Written evidence submitted by Agency for Culture and Change Management (ACCM) (UK)
Re: Female Genital Mutilation Consultation
Declaration of Interest:
The report presented below is based on my work experience in campaigning to eliminate FGM from 1997 to 2008 when working for Agency for Culture and Change Management – Sheffield as National Director, and as Founder and Director of ACCM (UK) from 2008.
Working for Agency for Culture and Change Management – Sheffield (ACCM Sheffield) I took part in the review and implementation of the FGM 2003 and was funded the Home Office to organise three national conferences in London, Cardiff and Birmingham, between June and July 2004, to promote the new Act. I was also involved in the advice, review and the launch of the Scottish FGM Act 2005 in Glasgow in September 2005. I set up ACCM (UK) in 2008 as no organisation was tackling female genital mutilation in Bedfordshire, Luton, Buckinghamshire and Northamptonshire was taking place to start this important work locally. I continue to work with grassroots, professionals and other groups around the UK, including Scotland, providing training, information, advice and support on FGM and other harmful practices. ACCM (UK) works with other agencies in Europe through its membership of EURONET-FGM where I am on the Board of Directors, and other international organisations especially in African.
I am a member of various Local and Government Forums on FGM as well as other forums for other forms of violence against women. My recent consultation was as a panel member on Child Marriage Consultation, final report launched in November 2012 at the Houses of Lords.
I hope that my contribution to the Female Genital Mutilation Consultation will be useful and helpful to enable the Committee. If you require further information or wish to talk to talk to me about my report please do not hesitate to contact me. Look forward to hearing from you.
Yours sincerely,
Sarah McCulloch Director and Founder ______
79 Female Genital Mutilation Consultation
ACCM (UK)’s contribution to the consultation:
1. How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
The existing legislative framework on FGM is effective as this was followed by Multi –Agency Practice Guidelines: Female Genital Mutilation to help professionals understand FGM issues and how to approach, treat and support victims and those at risk.
Since 2004 after the launch of the FGM Act 2003 a lot information was produces and circulated about FGM by various Government Departments including Education, Home Office, Foreign and Commonwealth Office and Health. I was personally involved in drafting, producing and distribution of some of the information to professionals, third sector and grassroots communities. All, but a few, ignored the information or did not take FGM as a serious issue that needed their attention. Outside London, only Sheffield, Liverpool, Cardiff, Bristol and Glasgow in Scotland took FGM seriously, developed FGM Protocols, provided training to all professional agencies and undertook work with grassroots communities.
The Barriers to achieving a successful prosecution in the UK are:
• Most important is that victims are also themselves perpetrators or people who will plan or encourage young ones to be subjected to the practice. • FGM is a unique problem in that all victims are all female, closely related and perform the practice because it is an old tradition done in the name of love, care and passion. • FGM is seen as normal, everyone has been through it, suffer the same consequences and therefore not seen as a problem • Because girls and women accept that this is their culture as their older female relatives have been through it with honour they find it very difficult to complain or report the matter to the authorities. • FGM is a very personal and intimate issues relating to a private part of the body, culturally it is not easy for people of African, Asian or Middle East to talk about their private part of the body publically. This makes it difficult for victims of FGM to talk about their experiences publically and the case of standing in court talking about how their genital areas looks, feels or is different in front of people is a NO NO and emotionally difficult. Although I am known to and trusted by FGM victims they refuse to talk about themselves to the media or anyone outside their group. • In the UK we have communities who come from countries or tribes that have a strong sense of family and community loyalty so that people find it difficult to step out of line. For those who do they are seen as traitors or dishonouring the family and community and are often subjected to serious threats including death, isolation from family and the community as proved by the recent TV Documentary, ‘Cruellest Cut’ by Leyla Hussein that angered the community leading to death threats and police protection. Since 1997, ACCM (UK)’s staff and volunteers have faced and still face similar threats and abuse every time they go out into the community to talk about FGM. These threats put people off reporting cases or victims coming forward to talk to authorities. • Victims are fearful of coming forward for fear of losing their families and communities as they may have to leave and move somewhere else which makes it difficult for young girls especially. An example of this is the fact that we have strong young women, victims of FGM, who are now speaking out but none of them have brought a case against their families, often mothers or grandmothers.
80 • Professionals and service providers are afraid of tackling the issue even asking the questions; doctors do not examine girls or women even if they present themselves with problems such as passing urine or heavy periods, if they did they would establish the problem and report the case. • Many professionals or organisations are ignorant of FGM (despite information being widely available) or prefer not to be involved. Majority, especially schools heads and GP surgeries, are fearful of being accused of being racist or are afraid of undermining the good community relations /cohesion they have established with the communities. An example a teacher from a Milton Keynes school arranged for ACCM (UK) to give a talk to girls in upper levels but this was cancelled by the school head who was not keen for the subject to be discussed. If girls or professionals are not informed they are unlikely to have the confidence or information to enable them to report or seek advice or help. • Grassroots communities are not aware of the law or safeguarding issues as this information is not given to them at the outset when they seek Visa, seek leave to remain in the UK or register with schools for their child or when they register with a GP.
2. Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
• In the UK the Somali community form the largest group of girls or women at risk and found in almost every large town or city around the UK. • In Leeds, the Sudanese community are most at risk • We currently have large numbers of girls and women from West Africa including especially Gambia with a large number residing in Birmingham • There are large numbers of Kenyans as well but they are more scattered around the country and in small towns such as Bedford • It also need to be said that due to Government dispersal policy small towns now large migrant communities some of whom are from FGM practicing communities such as from Iraq, Iran, Mali, Uganda, Somalia, Eritrea and Gambia to name a few I am aware off.
3. What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
When it comes to FGM the most important strategy is that of multi-agency co-operation
The third sector often made up of staff or volunteers from communities themselves know who and where FGM practicing communities are, established trust and working partnership with local groups including community and religious leaders. The third sector is best funded and supported to deliver culturally sensitive training, awareness raising to communities that will not be seen as racist or challenging their culture. This established relationship enables third sector to work closely with services providers and professionals to develop appropriate and relevant services to support referrals, treatments of victims and protection of those at risk. It is very sad to see that professionals do not utilise third sector’s knowledge and expertise instead we tend to be ignored, our requests to provide training or support to schools or GPs surgeries is often ignored and events organised for local professionals often see no police officers, school teachers or health professionals, especially GPs, attending. There is a lot a need to improve this important co-corporation between third sector and professionals.
81 Education – they should be well informed about FGM and FGM practicing communities that use their schools. They can then allocate a teacher who girls or parents or community members will be comfortable to talk to about the subject. This worked well in some Sheffield Schools between 2001 and 2007 as they were able to refer cases or those at risk to Safeguarding Teams even if they were just travelling on holiday. Schools are so politically correct that they never allow any information on FGM in schools; requests for training staff or giving talk to pupils are often ignored or turned down in the name of not wanting to antagonise communities or fear of unknown people (third sector staff, volunteers) accessing children. Schools need to be informed that third sector staff and volunteers are professionals and do work closely with vulnerable children and adults safely and have appropriate CRB checks.
Health professionals should have mandatory training on FGM so that they can apply their training and understanding in treating girls or women victims, identifying and asking questions where and when the practice took place and reporting any suspicions to rightful authorities such as Safeguarding or the policy for further investigation. A question on FGM, like domestic violence, should be part of questions women are asked when they present themselves in hospital when pregnant. Not only will the health professionals be able to plan the management of women’s pregnancy, but also give them information should they have a baby girls or have other female children in the family.
GPs who are at the first point of call should be fully aware of FGM and report all suspicious cases instead of hiding behind confidentiality. In Sheffield where GPs’ surgeries were trained and informed many girls were saved when cases or families seeking vaccinations to travel from FGM practicing countries were reported to either Safeguarding Teams or ACCM Sheffield staff.
The Police and Social Care professionals should be fully trained and informed, have FGM Protocols in place with contact details of a specific team that will react to a referral quickly and effectively without them suffering political correctness or fear of being called racist. The main reason being that cases have been lost as Police and Social Care services have either ignored the referral, or just accepted what the elders or parents told them ignoring all the evidence. Since FGM became law, the Police and Social Care services have become too accommodating about minority cultures by relying too much on Religious and Community leaders when they are part of the problem, they rarely condemn these practices as they are protecting their own positions within the community. Also my concern is the claim that because they have never received a referral Safeguarding teams and the police feel that there is no problem in their local area. If they co-operated with the third sector who have inside knowledge and information on communities they would be better informed to make decision especially on children at risk not just FGM, but also FM, Child Marriage and HBV.
4. How can the systems for collecting and sharing information on FGM be improved?
The Multi-Agency Practice Guidelines: Female Genital Mutilation stresses collection and sharing of information amongst agencies. These Guidelines should now be made legal and mandatory where all information is recorded by all agencies including the third sector. This information can then be collated, analysed and report provided by an expert or agency appointed by the Government, say every three years. The information will then be shared, new strategies and policies to improve campaigns. For example, since 2000, with the exception of students or journalists seeking information for their courses or reports, ACCM (UK) has never been consulted by any organisation or agent seeking to collect information on our FGM work to feed into Government policy. 82 It is also important for the Committee to note that FGM is not just a London problem, it is a UK-wide problem and that all agencies undertaking work on FGM outside London should be equally consulted and involved.
5. How effective are existing efforts to raise awareness of FGM?
• Existing efforts to raise awareness are so frustrating, slow and limited because of: • Lack of specific funding to tackle FGM • FGM is a very intimate, personal and complex subject to work with especially when the women you are targeting may be victims but you really don’t know because you cannot ask them unless they themselves say so, which is often they don’t • Complex communities, very mobile, scattered around the UK, who do not feel or see FGM as a problem or a violation of a child’s rights • Professional services such as schools, GPs, police and safeguarding having little interest or ignorant about FGM and unwilling to take up the challenge • Lack of support from Local and Central Government for grassroots campaigners who find themselves in line of fire and death threats • Every time there has been huge media interest (especially in 2000, 2003-2004, 2007, 2009 and 2013-4) or publicity it has resulted in negative and angry response from FGM practicing communities who feel they are being victimised. The use of such words as ‘barbaric’, ‘inhumane’, ‘violation of child’s rights’, ‘abuses’ often leave these communities fuming with anger. It is common for women especially to get very upset and later refuse to engage with anyone on the subject as they feel they have been violated, assaulted and the whole experience brings back the pain when they were subjected to the practice – that they too are victims and only doing the best for their young children. These media campaign do more harm by turning communities against campaigners or refuse to attend any awareness raising events. • Due to community hostility and complex nature of FGM it is difficult to find staff or volunteers to work on the subject – those who do must have thick skins to cope with abuse or harassment especially if they are from the communities themselves.
6. How can the available support and services be improved for women and girls in the UK who have suffered FGM?
• Currently majority of funding and clinics are in London, more funds for outside London organisations. • ACCM (UK) works UK wide and feels that there should be an FGM clinic with trained staff and interpreters in every Region or main city with large population of FGM practicing communities. At the moment we are referring women from Milton Keynes, Luton or Northampton to London or Birmingham which means that most girls or women will be unable to attend because of travel costs or that family will find out if they spend such long time away from home. • Available support and services are inadequate as they are poorly resourced, for example some clinics, in Birmingham or Bristol, only open certain days or times. • Hospital management should be made to provide clinics as part of their maternity services to provide services for local women especially reversal treatments for young women with serious healthy problems.
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• Bring back Health Visitors who visit families, as they will be trained to monitor children, give information to mothers and families and report any suspicions. • There should be relevant services to support victims who may want to speak out but fear to do so because there is no funding to support them or housing for them to go where they can be safe.
7. Why UK is not France
As a member of EURONET – FGM and currently a Board member I have links with other campaigners in France and it is true France does things differently. However:
• In France there is little accommodation for minority cultures that do not fit in with French way of life or laws. While in the UK we are more tolerant to the extent that illegal harmful traditions practiced by minorities or immigrants go unchecked due to this sensitivity. • Also majority of communities residing in France are from French colonies such as Mali and Senegal and these are not closely knit or protective as say the Somali or Gambian communities who never speak out or report fellow members to authorities or outsiders. The UK FGM practicing communities do have own internal community or tribal conflicts but when an outside tries to join in that outside is often completely shut out. Hence, the London Metropolitans Police’s 2007 £20,000 reward not resulting in any useful information leading to the prosecution of cutters. I responded to this reward stating how it will not succeed in my Editorial article in the Guardian on 17th July 2007: http://www.theguardian.com/commentisfree/2007/jul/17/comment.gender
**The best way forward in working closely with communities empowering them with information to help them understand the issues and work to eliminate these practices themselves, such as what is happening in villages in Africa. New laws or prosecutions will not change anything.***
Agency for Culture and Change Management February 2014
84 Written evidence submitted by Avon and Somerset Constabulary and the Police and Crime Commissioner
Introductory Remarks
1. This response to the Home Affairs Select Committee (HASC) has been prepared jointly by Avon and Somerset Constabulary and the Police and Crime Commissioner (PCC) Sue Mountstevens. 2. Tackling domestic and sexual violence is a PCC priority in Avon and Somerset and an important element of this is Female Genital Mutilation (FGM). The Constabulary and PCC stand together in confronting this child abuse and this response to the HASC sets out issues from both an operational and strategic perspective in Avon and Somerset. 3. This document provides a response to the six questions posed by the HASC, under sections A to F.
A. How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
Effectiveness of the legislation
4. FGM laws currently rely on women and girls reporting their own families to the police. Furthermore girls who have undergone FGM are likely to be aged 10, 11 or even younger. Whilst we can do all we can to make clear that FGM is an offence, FGM referrals within the constabulary demonstrate that girls are not coming forward to give evidence against their parents, rather referrals are picked up by professionals who recognise warning signs of a potential FGM concern. 5. Serious consideration should be given to developing new laws/legislation around a specific offence of causing or allowing a female to undergo FGM and ancillary offences of failing to report to health professionals that a child has undergone FGM if this is discovered by professionals at a later date and there is difficulty identifying who has carried out the FGM. 6. This approach could prove particularly useful in cases where a victim will not disclose or acknowledge that they have had FGM, professionals are unable to date the FGM injury, parents are not offering any adequate explanation and professionals are unable to evidence FGM offences suitable for a prosecution under the current laws.
Barriers to achieving a successful Prosecution
Issues in victims reporting 7. Victims may be too young, vulnerable or afraid to report offences or give evidence in court. 8. Victims are reluctant to report parents/family for fear of prosecution and reprisals. 9. Reluctance to report the crime because it is a cultural taboo and may also be coupled with pressure from the family and wider community to retract evidence.
Levels of agency referrals 10. Since 2009 police have recorded and specifically flagged FGM cases. The sources of referrals come from Health, Schools and through Children and Young People’s Services (CYPS). There are virtually no reports coming direct from community/public to the police. 11. Agencies are still very tentative and reluctant to share information and report cases
85 to the police. There is a misconception that the case must be an actual emergency before Police can be involved. Furthermore professionals are concerned about the trust developed with women and girls who seek help from health professionals for FGM and are genuinely concerned that sharing of information will put off women and girls from seeking help in the future. There is a fear it may exacerbate the issue of under reporting and may even drive the issue further underground. 12. Ultimately, buy-in at a senior level within organisations is required in order to change processes and working practices at a tactical level.
Community engagement and diversity of staff within the police 13. The police forces are still under represented in BME staffing levels and do not reflect the communities we serve. 14. More needs to be done to better engage police with affected communities as it is apparent from our referrals levels that if FGM is happening and there are at risk girls, we are not being told about it. 15. The low levels of reporting can present a challenge in justifying that FGM is a huge issue and one that requires further investment when competing against other priorities. However unless you proactively look for and tackle this issue it will remain a hidden form of abuse.
Issues related to investigation 16. Low levels of reporting mean police do not gain the experience, knowledge and competence required to be confident in the investigation of FGM cases and reinforce any training provided. 17. Evidentially there are challenges with medical professionals accurately dating when FGM has taken place, challenges in obtaining reliable and admissible evidence from the country where the offence takes place if outside the UK. 18. Issues are experienced in cases relating to non UK residents who are seeking asylum, or do not have leave to remain in the UK but fear that they will be subject to FGM if they return to their country of origin. In these cases where we have a concern, the law does not cover these circumstances and we have to rely on working relationships with UKBA in order to influence an asylum appeal to protect and safeguard women and girls.
Few cases referred to CPS 19. Having investigated a report, the police may not identify any credible evidence to support a suspicion that a potential victim may be at risk. 20. The police may be satisfied that effective protection and safeguarding measures are in place where potential victim was suspected of being at risk. The successful safeguarding of a victim and prevention of FGM is paramount and the most desirable outcome in terms of the wellbeing of the child or woman. That said all opportunities for criminal investigation and prosecution are followed up diligently and robustly. 21. The CPS can only charge and prosecute cases of FGM that have been investigated and referred to them by the police. As systems for gathering and acting upon intelligence develop, the numbers of cases being referred to them will hopefully increase. Encouragingly, the South West Area Criminal Justice Board at its meeting in December 2013 agreed to produce a local protocol which will establish specialist single points of contact for FGM cases.
22. The approach to CPS for advice and/or a charging decision is a stage in the process that is in many respects ‘quite far down the line’. There is a little doubt that a more cohesive and inclusive multi agency approach to flagging concerns and sharing information would increase the number of referrals, investigations and likelihood of successful prosecution.
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B. Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
23. We still do not have a clear understanding of prevalence due to data issues. The PCC has invested in a prevalence report for the city of Bristol which will be published in March 2014 which calls upon multi agency partners to share their data to understand the true levels of FGM.
C. What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
24. All agencies have a key role to play in the identification, education, health, wellbeing and enforcement of law to tackle the issue of FGM. This is clearly a child protection and safeguarding issue. Clear guidelines on flagging, referrals and intelligence sharing should be enforced as per the recently published Intercollegiate report.1 Progress locally is driven by passionate individuals whereas this issue should be embedded systematically as a matter of course. In order to make this change there needs to be engagement at a strategic level. The PCC is starting to have these conversations with the relevant agencies. 25. Front line professionals should be trained and understand what to do when presented with FGM victims. The PCC is still meeting front line professionals who don’t know what FGM stands for. 26. In Avon and Somerset we have a good multiagency partnership work in Bristol. This is not replicated across the force. Good multi agency work is not just about holding a meeting, but also the effective team working and relationships between those individuals to make a difference. Passion and commitment to tackle this issue and drive forward change is paramount. There should be multiagency working at both a tactical and strategic level.
Below is an outline of some of the ways Avon and Somerset are developing their response to tackle FGM cases:
27. Police consider visiting every family relating to an FGM referral irrespective of whether there is evidence of an actual crime or not to gather a better intelligence picture and reinforce the law within this country and signpost for advice. 28. Work is underway to ensure that Police and CYPS have effective mechanisms in place to trigger follow up visits and reviews of those families deemed to be at risk of FGM. This is of particular significance where there is insufficient evidence to support the concerns at the time of the referral. If the family are from a FGM practicing community and unless the parents show a clear and sustained commitment to keeping the female children safe from FGM, their situation has to be the subject of ongoing monitoring and scrutiny. At present there is too much reliance on the families/victims re-contacting us if they are concerned and a lack of ownership and responsibility from agencies to address this issue. This process of monitoring needs to involve all agencies including Health and Education along with Police and CYPS. 29. Working with partner agencies to assist them in developing more effective ways of recording FGM cases and effectively referring these cases to the CYPS and Police in a timely manner to increase reporting and increase the opportunity to investigate and prosecute FGM cases.
1 (2013) The Royal College of Midwives, Tackling FGM in the UK: Intercollegiate recommendations for identifying, recording and reporting http://www.rcog.org.uk/files/rcog-corp/FGM_Report%20v10%20a~final%20forwebsite.pdf
87 What could be done nationally to assist:
30. Encourage greater engagement from schools. FGM to be mainstreamed as part of the curriculum, encouraging debate on the issue. Support and information should be available for all students requesting this along with signposting to more specialised assistance. 31. To ensure that Health, Education and other professionals from relevant partner agencies have adequate awareness of multi-agency practice guidelines and safeguarding procedures and are confident in their abilities of how and when to refer cases to Police. 32. Encourage engagement from UKBA in order to raise the profile of FGM. 33. Commission further work to gather useful and meaningful data to better gauge the prevalence of FGM and improve our understanding of the problem to assist in developing more effective ways of tackling FGM. E.g. All agencies to partake in a national data collection process over a set period of time. 34. Education /Schools – FGM to form part of safeguarding training for staff in education with a mandate this must be provided.
D. How can the systems for collecting and sharing information on FGM be improved?
35. Our approach is far too reliant on passionate individuals within agencies committed to tackling this issue, but as yet this is not embedded at every level to really make the changes required to effectively gather and share data. There is still much reticence and sensitivity from other agencies about sharing data with police, for fear of breaching patient confidentiality or being perceived as having a racist approach towards individuals from affected communities. 36. At present although agencies within Avon and Somerset are sharing information this is not nearly enough. Police are still receiving only a handful of referrals about FGM and very little intelligence about FGM as information is not shared freely enough. Crucially, FGM is not considered by the system as a whole to be child abuse, therefore data is not being shared in the right way. 37. Moreover, individual agencies need systems which allow them to record and flag cases so that the data is able to be used and shared effectively in the first place. 38. A national direction and framework which requires agencies to share on a more frequent and robust footing is required and would alleviate the current debate between agencies about what level of information can and should be shared. It would be most helpful if a national FGM information sharing protocol was agreed.
E. How effective are existing efforts to raise awareness of FGM?
39. In Avon and Somerset we are working closely with our partner agencies to support International Zero Tolerance day in February and have a number of events planned throughout the month. Annually the Constabulary and PCC support and contribute towards a FGM summer awareness campaign, with publicity and planned events taking place through the summer months starting from May. 40. At a national level, more should be done to raise the profile of FGM amongst the public and to engage the media in publicising the issue in a variety of ways and with the aim of achieving the greatest impact (e.g. advertisements on television; billboards; using social media to raise the profile and encourage discussions on Facebook and Twitter). 41. FGM is a subject that requires a constant repeat message to everyone in order to raise awareness and move away from only focusing our attentions on educating professionals and individuals who are likely to be affected by the issues of FGM.
88 FGM needs to be continually and widely publicised to reach as many people as possible and make this “hard to talk about” issue easier to talk about and get it out in the open. The more the public understand what FGM is, the more chance we have of someone coming forward to report FGM concerns and increase our chances of safeguarding women and girls and taking enforcement action where required. Overall not enough people understand FGM and also do not even know what FGM stands for.
F. How can the available support and services be improved for women and girls in the UK who have suffered FGM?
42. Better awareness of the organisations who can provide support is required, but crucially there needs to be adequate provision of such support services. Consideration should go into the needs of FGM victims by commissioners from all relevant agencies, including for example the Ministry of Justice as part of its funding for victim services (where the commissioning of some services is becoming the responsibility of PCCs and more specialist needs are to be met via nationally commissioned services). However, the fundamental issue is that we still do not have a clear understanding of the prevalence of FGM – data is required to effectively commission services and provide the right support.
Avon and Somerset Constabulary and the Police and Crime Commissioner
February 2014
89 Written evidence submitted by the London Borough of Havering
How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
The lack of a successful FGM prosecution does suggest there is a lack of awareness of FGM legislation. Possible barriers to achieving a successful prosecution include: . There has been no national campaign that remains in the public psyche and reinforces the message that FGM is illegal and has been since 1985. . Victims who are often relatively new to the country are being asked to criminalise their parents and families and in doing so isolate themselves further. . Family collusion and divided loyalties create a culture of non-disclosure.
Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
Havering has a small BME population, however there are communities on borough from those areas of the world that practice FGM namely, Ghana, Nigeria, Kenya and the Middle East.
Barriers to identification and intervention include:
. For those areas with low numbers of BME communities FGM cases are not seen on a frequent basis and may not always be obvious. . A lack of training for front line staff with the greatest opportunity to identify girls and women at risk. . Multi agency procedures are needed for a co-ordinated response, especially in front line organisations – police, health, education, CYPS and the voluntary sector. Ideally each agency should have a named individual who is a single point of contact for all FGM cases. . FGM needs to be mainstreamed into PHSE and sex education lessons to ensure that all children are aware of the procedure and health consequences. . Safeguarding lessons which include FGM could be incorporated into ‘citizen awareness’ education for adults and children newly arrived from practicing communities. . Further work with mosques, churches and traditional churches. . A lack of tailor-made parenting programmes for communities effected by FGM to prevent future parents subjecting their children to the same practice. . Men need to be included in discussions around FGM during pre-marriage counselling, following child birth, and rites of passage ceremonies.
90 What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
All agencies have a duty to:
. Prevent FGM through education, raising awareness of legislation and training staff to identify vulnerable girls at risk . Intervene when FGM has taken with specialist support . Prosecute those assisting FGM
Multi agency co-operation could be improved by the establishment of a multi-agency meeting to discuss FGM cases.
How can the systems for collecting and sharing information on FGM be improved?
. The establishment of a multi-agency meeting to discuss FGM cases would enable better collation and sharing of local data and information.
How effective are existing efforts to raise awareness of FGM?
. Campaigns need to be linked in with key events to ensure maximum impact: - International Day of Zero Tolerance to FGM - International Women’s Day - International Day of the Girl Child - International Day for the Elimination of Violence Against Women and Girls - Link in with Women’s Aid, NSPCC, Child Line and public health campaigns - Raise awareness during key times of the year such as school holidays when girls may be taken overseas
How can the available support and services be improved for women and girls in the UK who have suffered FGM?
. Provision of culturally specific services including interpreters to ensure that women are able to speak confidently. . Provision of trauma counselling for women who have gone through the procedure. . Local support groups which are facilitated by an FGM specialist. . Empowering women to tell their stories through the use of art, film and writing which in turn can be used to help other women.
91 Written evidence submitted by Ralph Tilby
Terms of reference 1. I worked as a consultant to the Metropolitan Police Service (MPS) between 2003 and 2010 in a number of project management and process modelling roles. This included the development of a new policing model for Sutton which accommodated a £1million reduction in spending and achieved a 14% reduction in crime in 12 months. I hold an MBA from the University of Exeter and have a specific interest in viable systems and complexity management. I am writing this submission to highlight what I believe to be some of the principle reasons why the MPS has failed to secure a single conviction for FGM related crime in 28 years. My experience only relates to the MPS but I suspect that the observations that I have made may also be relevant to other police services within the UK.
A centralised response to a widespread and complex crime. 2. The MPS response to FGM in London was to set up project Azure in 2006, a centralised unit in what is now the Specialist Crime and Operations Division. In seven years Azure has failed to secure a single conviction and yet there seems to have been an extraordinary reluctance within the leadership of the MPS to change and review a business model that has so obviously failed. 3. The MPS’s own estimates suggest that there are 6000 girls at risk from London every year. Identifying those who are at risk, engaging with the communities involved and developing a London wide safeguarding children strategy requires the involvement of thousands of professionals from multiple agencies if it is to be effective. It is difficult to comprehend how a small centralised unit could possibly facilitate such a response and the results speak for themselves. 4. To eliminate FGM in London requires every single borough to develop a safeguarding children from FGM strategy. The structures and integrated working to protect children from other forms of violence and abuse already exist. FGM is child abuse and it should be incorporated into the work of the existing child protection structures that can be found on every London Borough. Community policing and in particular neighbourhood policing (vital to create the relationships with at risk community groups) is the remit of Territorial Policing not Specialist Crime and Operations. This would imply that the ownership of this problem has not even been allocated to the appropriate division. 5. A complex pattern of crime involving thousands of victims requires an equally complex response involving tens of thousands of professionals from police, social services, education, health etc. It is a fundamental law for the development of a viable system that the complexities of the controls within the system are sufficient and adequate to address the complexities in the environment in which the system is embedded. The complete failure of the police response to FGM to date reflects their evident failure to recognise this basic law of complexity management.
92 Failure of Leadership 6. The leadership of the MPS must be held accountable for their abject failure to protect thousands of girls from the most horrific mutilation over 28 years. As a legacy of the old British Crime Survey Comparator Crimes the leadership seem to be fixated by volume property crime rather than the protection of vulnerable citizens from terrible risk of harm. I would ask the committee to enquire if the topic of FGM has ever been raised at Management Board level as an issue for the MPS? Where is the record of the performance management and review of the police’s failure to bring a single perpetrator of crime to justice? 7. Can we imagine the leadership of the police being this complacent if they failed to detect one in 6000 robberies a year? The impact on the victims, the women who have been subjected to FGM, is every bit as traumatic as the victim of a robbery, perhaps more so as they will never be able to physically recover from the violence that they have been submitted to. 8. I, like many other campaigners feel that it is only by extraordinary pressure from outside the police that the subject of FGM is now starting to be taken seriously. I believe that, despite recent high level female appointments, the MPS is still primarily a patriarchal organisation that repeatedly fails to adequately address the issue of violence against women in the community. It will take a comprehensive change of culture at the top of the organisation to reverse this.
Summary 9. It is my belief that unless the committee can persuade the police take a completely different approach to addressing the widespread incidence of FGM upon vulnerable young girls in London, we will condemn yet another generation to this horror. If the police cannot be convinced that it is a priority to protect vulnerable young girls from such horrific crimes our society is in a very perilous place indeed.
Ralph Tilby
February 2014
93
Written evidence submitted by the Intercollegiate Group on FGM
Executive Summary
1. The Intercollegiate Group on ending FGM in the UK comprises the Royal College of Midwives, Equality Now, the Royal College of Nursing, the Royal College of Obstetricians and Gynaecologists, Unite/Community Practitioners and Health Visitors Association. As frontline professionals encountering FGM and its consequences regularly in our work, we consider FGM to be an extreme form of child abuse. The health complications affect the physical, mental, emotional and social aspects of life. The Intercollegiate Group recently published ‘Tackling FGM in the UK: Intercollegiate recommendations for identifying, recording and reporting. This report addresses much of the committee’s terms of reference for this inquiry.
The Intercollegiate Group calls for the following actions:
• Recognition that FGM is child abuse and a violation of girls’ and women’s human rights and should be treated as such. It needs to be fully integrated into existing child protection and safeguarding strategies. • Frontline professionals in touch with families and girl children must be provided with the skills, knowledge, confidence and understanding of what FGM is, what their responsibilities are in relation to FGM, and why and when to act. • The NHS needs to know the scale, type and location of women being seen with FGM, to record details consistently and accurately and to share this information with other appropriate government departments including the police and social services. • The focus of work to prevent FGM should be early identification and protection. The NHS should establish a shared responsibility for ongoing management of girl children identified as at risk with social services, with a national understanding of the respective responsibilities of each department ensuring that the response to a child identified as being at risk of FGM is measured and reflects the specific individual responsibilities. • Loopholes in the law should be addressed. The FGM Act should not be limited to British citizens or permanent residents but it should reach any girl child of any status in the UK. The lack of clarity of the legal position on re-infibulation also needs to be established.
How effective is the existing legislative framework on FGM and what are the barriers to achieving a successful prosecution in the UK?
2. A key barrier to achieving a successful prosecution relates to the low levels of reporting of the crime of FGM. The existing laws (1985, 2003) rely on victims of FGM to report the abuse to the police, despite the fact that the majority of victims who undergo FGM are under the age of 10 with some under the age of 5. The evidential standard requires that victims of FGM testify in court even though a clinical examination could determine if the child has undergone FGM.
94 3. Testimonies are difficult to secure as older girls (minors) who disclose FGM face considerable pressure by family members and the wider FGM practising communities to remain silent. In some instances older girls (minor) have refused to give evidence because of fear of their parents being sent to prison. This is in spite of attempts by the police to provide psychological and other extensive supportive measures.
4. The law does not see FGM as a criminal dereliction of parents’/guardians’ duty to protect their children and there is a need to shift the responsibility onto the parents as happens in other EU countries. There is also an over emphasis on prosecuting the “cutters” when in reality due to the traumatic nature of the act, the girl is unable to identify the “cutter” who is not always resident in the UK. It is also our understanding that most prosecutions for FGM fail the test of demonstrating a period of harm or neglect leading up to the act of child abuse/FGM.
5. In general, allegations of the abuse of children come to the notice of social services and police via third persons such as teachers, health professionals or the wider public. However there is currently a lack of referrals from all professionals in relation to FGM. This under-reporting is due to a number of factors: misplaced “cultural correctness” and the lack of a clear pathway for integrating FGM into Health, Children Social Care, Education and child protection systems and, as a result, the police are unable to build a significant case for the prosecution
6. The current law does not cover girls whose parents have temporary residency status, for example, students or refugees, who are taken abroad to undergo FGM and are brought back to the UK. Not applying the law to temporary residents creates a loophole allowing perpetrators to avoid prosecution – the police have had to drop such cases in the past.
7. Type III FGM or Infibulation can result in a very small opening which may cause difficulties in urination, menstruation and sexual intercourse, as well as serious problems in childbirth. During delivery the constricted vulva in type III FGM needs to be opened up. There are reported cases of women de-infibulated during delivery and returning in subsequent pregnancies having undergone re-infibulation. There is a lack of clarity amongst health professionals and prosecutors as to whether re-infibulation constitutes FGM or is a criminal offence. The World Health Organisation highlights the importance of the need for midwives to be trained to open up type III FGM but states that re-infibulation is equivalent to performing the initial act of FGM and poses the same threat to health (WHO 2001).
Which groups are at most risk of FGM (whether in this country or abroad) and what are the barriers to identification and intervention?
8. Most of the girls and women who experience FGM live in 28 African countries where national prevalence data on FGM is available.
9. A study published in 2007 estimated that 66,000 women were living with FGM in the UK and a further 30,000 girls under the age of 15 were at high risk (FORWARD 2007). This data is currently
95 being updated. Figures are likely to have increased due to increases in immigration and increased birth rates among FGM practising countries.
10. The primary difficulty faced by those seeking to protect girls from FGM is identifying those who may be at risk. Girls at risk often live in marginalised communities and do not necessarily come to the attention of local social services teams. They may be subjected to FGM before they start school or when they are very young.
11. A further barrier to identification and intervention is a lack of recognition by professionals of risk factors and signs. FGM differs from other forms of child abuse and professionals are often unaware of what determinants put a girl at risk.
12. There is currently no co-ordinated system for early identification or prevention in place within health, social care or education to address FGM in a comprehensive, effective and consistent way.
13. The NHS, and in particular maternity services, is the obvious place to start with building a system of identifying women with FGM and those from practising FGM communities.
14. Once a woman is identified as having FGM or from a country where FGM is practised, her daughters, younger sisters or other female family members should be considered at risk and a range of preventative measures should serve to reduce this risk, including information provision on the illegality of FGM, the harm it causes and co-ordination with other frontline professionals.
15. There is currently no mechanism to ensure that any information gathered by one NHS body about a woman who has undergone FGM and has female children is communicated to any other relevant part of the NHS or social services or education. For example, if a woman identified by a maternity unit as having undergone FGM and gives birth to a daughter, there is no means by which that information is passed to her GP, health visitor, social worker, or school nurse, who will have further contact with the woman and her family.
16. It is well reported that when health professionals report a girl who they feel is at risk of FGM to Children Social Services, they are told that “suspicion” of FGM does not reach the required threshold for Children Social Services to take action.
17. Collecting data on FGM only at birth would not capture women who have had FGM but have no children; women giving birth may, therefore, not be representative of total numbers of women with FGM. However, collecting such data would give a comprehensive picture to enable effective planning and targeting of resources and services. There are currently a number of barriers to data collection on FGM in a number of health settings and maternity units, including:
• No national or statutory requirement to report FGM. No UK-wide standardised maternity notes - some paper, some electronic, or different systems. • FGM is not a compulsory question to ask about at the antenatal booking interview. • Staff are unaware or unsure of FGM, the questions they must ask and where to seek advice.
96 • Some units do not have clear protocols/pathway for what to do if FGM is identified. • Lack of awareness of FGM or failure to comply where protocols or pathways exist for FGM.
What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
18. Putting a stop to FGM in the UK requires a multi-agency approach and co-operation between all agencies that come into contact with at-risk children. The Report of the Inter-Collegiate Group recommended a system wide approach for embedding FGM prevention in the health, social care, education, and justice system and has outlined the roles and responsibilities of the key professionals:
Health:
• The Department of Health/NHS needs to document and collect information on FGM in a consistent and rigorous way. • All new patient registrations, including in Accident and Emergency and GP practices should include enquiries about country of origin to determine whether the patient and their family are from a FGM-practising country. • FGM in women giving birth should be coded in Hospital Episode Statistics and Maternity and Child Health data. • Every woman from, or partner to someone from, an FGM-practising community who attends antenatal appointments should be asked about FGM as early on in pregnancy as possible and the outcome of that discussion accurately recorded • All cases of FGM should be referred to the appropriate professional through a clear referral pathway so that an action plan can be developed. • All girls born to mothers who have undergone FGM should be considered at risk and there should be a referral to children’s social care. An action plan should be put in place for follow up. • FGM risk should be included in a child’s Personal Child Health Record or ‘Redbook’ and concerns referred to social services, schools & police, as appropriate. • Public health needs to ensure that FGM is integrated into the Joint Strategic Needs Assessment
Children’s social care:
• Children’s social care receiving information about girls at risk of FGM should organise an action plan for follow up with parents for ongoing education and monitoring until the child is 16 years old. This plan should be implemented in collaboration with health and education (health visitors, school nurses and safeguarding leads in primary schools) • Girls from FGM-practising communities who come into contact with youth offending teams, Children’s and Adolescent Mental Health Service (CAMHS) or on child protection registers for any other reason should be asked about FGM sensitively by trained professionals.
97 Education:
• Although FGM may be perpetrated on older minors, girls are most vulnerable during primary school education. • All teachers and school safeguarding leads should be fully trained on FGM as part of safeguarding. • All girls suspected of being at risk or of having FGM should be referred to children’s social care or to the police child protection teams. • Personal Health Social and Economic (PHSE) and Sex and Relationship Education (SRE) should be made mandatory in all schools as faith based schools are more likely to skip them.
Police:
• There needs to be a UK-wide training of all police on FGM as child abuse and their roles and responsibilities in collaborated in a systems approach with other stakeholders.
Third Sector:
• The third sector needs to be properly funded to support FGM victims as well as empowered to challenge the practice within their communities.
How can systems for collecting and sharing information on FGM be improved?
19. Data collection by health professionals should be routine, robust and mandatory and the Department of Health must ensure that information about the risk of future FGM is communicated to those in a position to take action to safeguard girls at risk.
• Every woman from, or partner to someone from, an FGM-practicing community attending pregnancy appointments should be asked sensitively about FGM as early on in pregnancy as possible and the outcome of that discussion recorded on electronic files. Maternity services are ideally placed to record such data. • FGM in women giving birth should be coded in Hospital Episode Statistics and Maternity and Child Health data. • All girls born to women with FGM should be considered at risk and an action plan developed for monitoring throughout her life. FGM should be included in the Personal Child Health Record (Red Book) and a referral to social services should be made, including a follow-up visit. • All new patient registrations, including Accident and Emergency attendances, should include detailed enquiries about country of origin to determine whether the patient/patient’s family is/are from an FGM-practising country. • Any girls from FGM-practicing communities who come into contact with youth offending teams, Children’s and Adolescent Mental Health Service (CAMHS) or child protection registers for any other reason should be asked about FGM sensitively by trained professionals.
98 20. Any discovery of FGM made through these inquiries should set in motion a standardised response set out in clear pathways, beginning with FGM status of the mother being logged in the Personal Child Health Record (Red Book) of the girl at risk. It is vital that any information on FGM is highlighted with the family GP, social services, attending schools (and, in particular, school nurses where they exist) and travel vaccination practitioners for follow up throughout the child’s life, particularly up to the age of 16. Such an approach follows the life-course model that is advocated by the various royal medical colleges in the Intercollegiate Group. All women identified as having FGM who bear female children should be referred to the Multi-Agency Safeguarding Hub (MASH) to develop an action plan and a home visit should be arranged during which more information on FGM, the law, and specialist support services would be provided to the family. A trial in Waltham Forest before the FGM services closed down had success with this approach and women were known to have welcomed this approach.
21. What is crucial here is that there is a joined-up, multi-agency approach in collecting and sharing information; there needs to be a continuous dialogue between all agencies throughout the child’s life. However, we need to re-double our efforts to ensure that FGM is systemised across health, social care, education and the police. Protocols for information sharing should be developed. Referrals should occur in conjunction with the provision of age-appropriate information on, such as the NSPCC helpline and specialist FGM clinics (e.g. African Well Woman).
How effective are efforts to raise awareness of FGM?
22. Outside of London in particular, frontline professionals have little awareness of FGM, its social context, legal status, or health complications. This is a barrier to reporting, but also reduces access to care; women presenting at hospitals with FGM have reported experiencing reactions of shock, revulsion and confusion shown to them by NHS staff.
23. Awareness of the law and the health and consequences of FGM in practicing communities is also poor – women suffering health complications as a result of FGM often fail to make the connection. Communities are often shocked to learn that FGM is not a religious requirement or an effective way to control women’s sexuality. Furthermore, information on both the law and available services is not reaching affected communities, so women are unaware of specialist support where it exists.
24. FGM is often described as a ‘hidden phenomenon’ because of the strong taboos associated with it, as well as a reluctance to ‘get involved’ because of ‘political correctness’.
25. We need a nationwide public awareness campaign that reaches practicing communities, frontline professionals, and the general public. Addressing FGM as a public health issue will require committed funding and we would like to see simple, discreet leaflets and posters in GPs, A&E, nurseries, schools, community centres, youth clubs, churches, mosques, etc. As well as addressing the negative health implications of FGM, greater clarity about the illegality of FGM and the prospect of prosecution should be used as an educational tool.
99 26. ‘Integrate Bristol’ provides a good example of an effective awareness campaign. With collaboration between local schools and the NHS, simple leaflets on FGM and the law have been disseminated throughout local health services. Discussion of FGM involving practising communities and young people has also been promoted through the use of conferences, videos, theatre, radio and workshops.
27. However, awareness campaigns cannot be left to civil society organisations alone; we need a systemised approach and multi-agency collaboration resulting in prosecutions; the law may be the best educator.
How can the available support and services be improved for women and girls in the UK who have suffered FGM?
28. It is vital that all women identified with FGM are referred for support and medical and/or psychological assessment as appropriate. Discreet information on the medical, psychological and rights-based effects of FGM – as well as the law – should be provided to all women presenting with FGM in antenatal or sexual health clinics. Psychosocial support is particularly lacking, and should be provided at antenatal appointments to empower women with FGM to reject it for their daughters.
29. The Intercollegiate Group is calling for the incorporation of FGM into pre-registration education, undergraduate medical education, postgraduate specialty education and training curriculum, and continued professional development for health professionals, teachers and social workers. A lead agency should be involved in producing e-learning materials for healthcare and other practitioners to access.
Members of the Intercollegiate Group
Royal College of Midwives
Equality Now
Royal College of Obstetricians & Gynaecologists
Community Practitioners and Health Visitors’ Association
Royal College of Nursing
Royal College of Paediatrics & Child Health
100 Written evidence submitted by Juliet Albert
1) The government could develop a standardized FGM information page to be filled and held in the child’s RED book of a woman with FGM. The Health Visitor must also have a statutory duty to ensure that the same information (including the mother’s FGM status) is on the mother and child’s GP computerised notes. This will ensure continuity of the information – so that if a female child is born to a woman with FGM this information is continuously flagged up to ensure that no crime is committed at a later date when the child is at the age of higher risk of FGM being carried out.
2) FGM must be included in ALL maternity booking notes. This should be a national standard. If FGM is disclosed/identified this should not only be documented in the woman’s hospital notes - but the Midwife at booking and at delivery should have a statutory duty to inform both the Health Visitor and the GP that the mother has FGM (regardless of whether she has a male or female child).
3) FGM should become a part of the mandatory training of all Midwives, health Visitors, GPs, Practise Nurses, Teachers, Obstetricians and Gynaecologists, Social Workers, Nurses, Teaching Assistants, Safeguarding Trainings etc.
4) If we are going to refer all women with FGM to social services then we must ensure that the women do not feel persecuted, and that a social care referral results in an appropriate response. Otherwise there is a real risk that when women are asked whether they have FGM, that they will say “no”. My personal experience is that women from vulnerable and refugee communities are fearful that social services will take their children away and this issue must be addressed and not simply ignored. My experience of social care referrals is that families are immediately treated as if they are criminals by social workers that are not knowledgeable about the causes and complexities of FGM.
5) It needs to be acknowledged that identifying the Type of FGM can be tricky. If a woman discloses that she has had FGM but there is no visible sign then she will have had Type IV. The introitus of a woman that had Type III FGM but has been deinfibulated will have the appearance of a Type II FGM. Etc. Many Midwives and Doctors, even after training, are still unable to distinguish between a Type II and a Type III.
6) The clinic that is run is funded by the NHS. We made an advert for Somali satellite Television. We receive approximately 5 phone calls per week from women all over the U.K. (https://www.youtube.com/watch?v=b6chv- YRDBU) or go to You Tube - Then key in Ealing NHS by Nabiil Nur
7) Some women attend the clinic because they wish to know what Type of FGM they have. Some women know that they are very closed and are suffering with painful attempted sexual intercourse. They come to be
101 deinfibulated using local anaesthetic. Some women ring us because they are in constant pain when they have sexual intercourse, when they pass urine, they often have frequent urinary tract infections, second and third degree tears etc – and they do not feel that they can talk to their GP – perhaps because the GP is male – or they have seen the GP but they are not being referred for specialist gynaecological support. The government could sponsor adverts in GP surgeries, hospitals and on satellite TV for FGM practising communities advising women where and how to get help.
There is no known conflict of interest with any of the above information.
Author:-
Juliet Albert Specialist FGM Midwife Queen Charlotte’s and Chelsea Hospital
102 Written evidence submitted by VCF – The Victoria Climbié Foundation UK
VCF is the leading organisation dealing with child abuse linked to faith or belief across all ethnicities. Our submission includes contributions from across generations and genders. We would like to thank Golden Opportunity Youth community group and their service users, as well as individuals from the communities with whom we work – for their input into VCF’s wider consultation on this issue.
Declaration of Interest
1. VCF – The Victoria Climbié Foundation was established by Mr and Mrs Climbié (Victoria’s parents) to campaign for improvements to child protection policies and practices, and to ensure effective coordination and links between statutory agencies and the BME community. 2. VCF has been working alongside FGM campaigners and survivors since 2003, to raise awareness of the laws, consequences and impact of the practice and offers a community perspective on this issue. 3. FGM is not a taboo topic; it is widely discussed within the community and people are open to talk about it and discuss its affects on women and the family. One thing people feel united against is the aggressive tactics used by some campaigners and the media. A lot of people feel that their culture is being held hostage by outsiders who judge their cultural norms without understanding why they exist 4. Revised legislation in the Female Genital Mutilation (FGM) Act 2003 provided the backdrop to a campaign by the Metropolitan Police to increase reporting of the practice from the community. One young campaigner seeks to place some context around what is now being discussed in the wider public arena, following recent actions to drive more reporting of FGM and thus prosecutions. 5. The practice of FGM is now being challenged by many within the community; with access to health care specialists. Members of the community are beginning to realise the many negative impacts of having the procedure carried out.
1. How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
1.1 At VCF, we believe it is important to address FGM from a children’s rights perspective and within the wider child protection framework in the UK, alongside other harmful practices linked to faith or belief.
1.2 The subject of FGM is no longer taboo; indeed, there is international consensus, even within relevant communities, that the practice of FGM on a young girl is child abuse.
1.3 In Uganda, scholars have been telling their people that the practice is not Islamic (haram) which has helped to reduce the practice. It is now established amongst communities that the practice derives from a cultural perspective rather than a religious one. This enables us to deal with the issue in a wider communication for those communities with no religious belief but practising FGM (as in the case of the South of Senegal, Casamance region).
103 1.4 Whilst the practice is still going on in Somalia, younger (second generation) Somalis in the UK accept the practice as wrong although believe it will take time to work through, perhaps a generation. Many believe that we need to address the root cause.
“From the view of our communities, FGM is a cultural practice that if not carried out would lead to being stigmatised and in most cases would probably leave that particular individual with little or no hope of being married. It isn’t just about chastity which many hold dear, it is also the view that anyone who isn’t circumcised would be unclean and ungodly and more susceptible to disease.”
“As a man, I don’t necessarily condone the practice of FGM, but it was important when I looked for a wife that she had undergone FGM – that’s our tradition. Now, I would absolutely not accept for my daughter to have the procedure.”
1.5 The increase and prevalence of FGM has largely been seen through health settings, often prior to, or during childbirth. FGM survivors previously accessed the help that they needed within the community, only turning to health professionals when they reach a point of crisis.
1.6 There is an ongoing conflict between health professionals; trying to support the health and wellbeing needs of those being treated, and the Police; who are proactively seeking referrals. The background of such cases is that the practice is viewed positively by those [family] who still support the practice, and thus is difficult for a young person to speak out against one’s family or community; not difficult out of fear, rather difficult because these are people that they love.
2. Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
2.1 The view of the community is that more work needs to be done ‘at home’ (in countries where the practice is prevalent); Somalia, Ethiopia, Egypt, Senegal, Gambia, Mali, sub Saharan Africa, and Middle East countries being cited by most. Many within the community do not know of the practice being carried out in the UK and to-date there has been a lack of evidence in this regard.
2.2 At VCF we do not think it helpful to single out specific communities. FGM is practiced across the world, albeit more prevalent in some countries than others. What is important is that the indicators will be the same for professionals who seek to understand the background and context to what many in the community see as a protective factor for their child. We need to be able to both identify, and respond appropriately to any child at risk of abuse.
3. What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
3.1 There is clear consensus on FGM as child abuse; there also exists a multi-agency approach and response within the existing child protection framework. Schools play a unique role in identifying risk although we would urge a sensitive and holistic approach to avoid reactive responses.
104 3.2 A young girl being supported by VCF was experiencing poor attendance at school. VCF intervention was sought to work with the young person during the Summer months with a view to her agreeing to a reversal of the FGM procedure in the Autumn. We supported the young person through our Active Listening programme for young victims of abuse; her school attendance improved once we were able to see the underlying causes for her absence. FGM was not the issue, rather we attributed her poor performance to poor parenting.
4. How can the systems for collecting and sharing information on FGM be improved?
4.1 At VCF, we believe that FGM can be eventually eradicated in the UK as prevalent communities are aware of the legislation forbidding the practice of FGM. Through better understanding of indicators , professionals are better placed to share information, but must decide how, when, where and with whom to share.
5. How effective are existing efforts to raise awareness of FGM?
5.1 It is making a huge difference because relevant communities are aware of the laws and furthermore over the years a debate and dialogue had been opened albeit the belief system remains ingrained within these communities. However, it is important that a lot more work needs to be done within the community. The legislation is seeking prosecutions rather than help to access preventative or health services thus there has been an unwillingness to come forward until crisis point has been reached.
6. How can the available support and services be improved for women and girls in the UK who have suffered FGM?
6.1 Ensure that FGM survivors are included at decision-making levels; identify their needs and allow them to be at the forefront of the campaign. Interact and engage in a manner that is holistic and sensitive.
6.2 Respect the culture and religious values of these communities; firmly address the harmful practices, not their beliefs.
VCF – The Victoria Climbié Foundation UK
Feb 2014
105 Written evidence submitted by Assistant Commissioner Mark Rowley, Metropolitan Police Service
Executive Summary
1. Metropolitan Police Service (MPS) is clear that Female Genital Mutilation (FGM) is a serious violent crime and a high priority within its child abuse strategy. Our response to FGM is led by a dedicated team called Project Azure within the MPS’ Sexual Offences, Exploitation and Child Abuse Command.
2. The scale of the problem is currently unknown, though in 2007 FORWARD estimated that some 15,000 girls were at risk of FGM in the UK due to their cultural heritage. The MPS has worked extensively with other public and third sector bodies in order to prevent offending, improve our intelligence in relation to offenders and prosecute where possible with many notable achievements. These include more than doubling referrals into the MPS from 26 in 2012 to 69 in 2013, submitting seven case files to the CPS in the last year for advice, and holding our first community engagement conference in March 2014.
3. To support this committee, the report sets out what the MPS believes are the key barriers to achieving prosecutions for FGM. These relate to:
a) The social context of FGM within communities which prevents reporting b) Limited referrals from across the public sector which limits information sharing c) The nature of the information that police do receive d) The legal framework which provides several potential loopholes.
4. The MPS offers the view that, in order to improve safeguarding and enforcement outcomes, referral processes across the public sector need to be improved so that instances of FGM are identified, such cases are disclosed to Social Care though existing child protection processes and that the law is reviewed to address several potential loopholes.
The Problem in London
106 5. The lack of reliable data on incidents of FGM means that the MPS is unaware of the true number of FGM victims, those who are mutilated in the UK and offenders who undertake this crime in London. In 2007 FORWARD estimated that some 66,000 women in the UK may have had FGM and some 15,000 girls under 15 were at risk of it due to their cultural heritage (‘A Statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales’ 2007). The Royal College of Midwives (RCM) details the prevalence in Africa and the Middle East and demonstrate that women from countries with the highest prevalence (over 80%) such as Somalia, Sudan, Egypt, Mali and Sierra Leone are at similar levels of risk in the UK (p4, p8 ‘Tackling FGM in the UK’ (2013)) which indicates the potential scale of this crime in London’s communities. The Evening Standard gave another indication when it reported in September 2013 that 2,115 women have presented at London hospitals over the past three years with FGM.
6. Estimating prevalence will become more accurate as the NHS develops an FGM data set which will assist the MPS by enabling us to assess the scale of the problem and develop a crime prevention and investigative response within high prevalence communities.
The Role of the MPS
7. The MPS is one part of the child protection system in which FGM should be managed. ‘Working Together to Safeguard Children’ (HM Government 2013) sets out the safeguarding responsibilities for public bodies and, specifically, s11 of the Children’s Act 2004 which requires Police, Health, Social Care and Education to fulfill their safeguarding duties within the guidance. It is the duty of the Local Safeguarding Children Boards (LSCB) to ensure this takes place. The Act makes clear that it is the duty of public bodies to share information with the Local Authority where they believe a child has, or is likely to, suffer significant harm (such as FGM). Section 47 Children’s Act 1989 makes it a duty for the Local Authority to make enquiries where a child is, or is likely to, suffer significant harm.
8. It is, therefore, the duty of the Local Authority to lead the response and for the MPS to work with the Local Authority to assist with their safeguarding duties. The police are therefore part of this process as the overall safeguarding responsibility sits with Local Authorities.
9. The MPS has, however, been extremely pro-active in developing its response to FGM. Since 2010 the Project Azure Team has undertaken initiatives to increase intelligence
107 relating to FGM, undertake prevention through maximizing safeguarding opportunities and improve our response to enforcement through our work with the CPS. This approach is summarized below:
a) Project Azure designed and chairs the multi-agency ‘FGM Strategy Group’ which directs activity towards enforcement outcomes with representation from across the MPS, NHS, LSCB and Equality Now. This has led to the creation of an MPS / NHS information sharing protocol, development of an outreach worker concept, intelligence development, engagement with schools and a wide range of support to the third sector. b) Led the NSPCC FGM hotline implementation. c) Provides training to the Child Abuse Investigation Teams who undertake all FGM investigations, and wider MPS first responders. d) Designs and develops investigative policy and best practice. e) Has a dedicated pro-active unit to develop intelligence opportunities to identify ‘cutters’. f) Promoted FGM awareness to teachers within schools with the production of a formal leaflet entitled ‘FGM - Guidance for Schools’ for 220 Safer Schools Officers and 108 neighbourhood teams. g) Designed and implemented Operation Limelight, a multi-agency awareness and intervention campaign directed at people travelling to and from high-risk countries. h) Continued liaison and development of the DPP’s National Action Plan.
The Barriers to Achieving Charges
10. The following paragraphs set out the barriers which the MPS face in seeking to safeguard children and investigate FGM.
Barrier 1 - The low level of reporting
11. In most policing scenarios victims of violent crime make allegations directly to police or through third parties. And though child abuse victims rarely report directly, child abuse often comes to notice through school, medical and other social interaction. However, FGM takes place in an entirely different context as the victim is often extremely young, she won’t necessarily understand that what is happening is wrong, the suspects are often family members and the community supports the practice. Additionally, FGM is not openly discussed and can often be considered a ‘secret society’.
108 12. The social context of FGM is best summed up by UNICEF who states, ‘FGM/C is perceived by practicing communities as a fundamental part of cultural group identity’ and ‘necessary to prepare girls for adulthood, wifehood, womanhood and motherhood. Put simply, FGM/C is a social norm for practicing communities’ (UNFPA and UNICEF Annual Report’ 2012 p ix).
13. These social drivers are extremely complex, embedded within traditional societies and unique. The first major barrier to policing FGM is, therefore, this social context and the subsequent lack of a willingness, ability or confidence to report FGM to police. The need for social attitudes to change so that communities firstly see FGM as wrong is necessary if this fundamental barrier to prosecutions is overcome. The data supports this statement. In 2013 the MPS received 69 FGM related referrals yet less than one third of these came from the family or community, with the rest referred by other agencies.
14. Though the MPS has a duty to prevent crime, in the context of FGM police activity alone is not enough. Social attitudes remain the key challenge, as the RCM state; ’Increased knowledge and awareness of FGM has not always resulted in abandonment of the practice, as community based surveys have shown that people can be aware of the illegality of FGM and its health impacts, but continue to support the practice’ (p 9). This reinforces the need for a wider governmental policy to drive the change needed so that offending reduces and people are more likely to report to police, support investigations and provide evidence at court.
15. The RCM states that that ‘Community based studies make it clear that although there are younger women who speak out, within the UK many women in affected communities who are under pressure to practice FGM. A more interventionist stance is needed and detection is considered a low risk’ (p11). The MPS supports this view and the need for a wider ‘whole system approach’ with community engagement and wider public sector information sharing to enable the MPS to safeguard children and investigate offences.
Barrier 2 - Low referral rates
16. The lack of information from communities makes referrals from education, health or social services the most important sources for identifying FGM. Table 1 sets out the low level of referrals since 2010 from all three agencies.
17. Note: Agencies may have made more referrals to Social Care which may, or may not, have reached the risk threshold requiring a disclosure to police. As such, many more
109 disclosures by these agencies may well have been made to Social Care, but not then passed on to the MPS.
18. Table 1
Total FGM related referrals to the MPS 2010 - 2013
Referral source Number of referrals
Health 34
NSPCC 6
Other police forces 1
Third sector 1
Metropolitan Police 43
Prisons 1
Education 17
Social Care 57
Unknown Source 1
Total 161
110 17. In the last year the number of referrals to the MPS improved dramatically which indicates an improvement in information sharing. As a proportion of the overall problem, referrals are still extremely low.
• 2010: 41
• 2011: 24
• 2012: 26
• 2013: 69
18. According to the RCM, a key barrier is the failure of professionals across a range of sectors to identify the signs of FGM or if they do, a lack of understanding of how to manage that risk (p14 -15). This is a significant barrier as without safeguarding referrals the MPS is unable to investigate offences. The risk is posed not only to the child in question but to other female siblings who are also likely to undergo FGM.
19. Information sharing needs to improve in order for the MPS to both understand the scale of the problem and be able to identify risk to children from FGM. The NHS does not currently collate prevalence data (though this is changing) and each of the 32 London Local Authorities have independent systems. As such, referral rates from Health, to Local Authorities and on to the police is unknown. Due to differing risk evaluation processes at each stage there is a sliding scale of referrals as assessments are made at each stage. A whole systems approach - to ensure information is referred appropriately across the agencies - is needed to improve enforcement outcomes.
20. A central issue is how Social Care evaluate the referrals they receive and whether they decide to disclose to the MPS. The London LSCB guidance indicates that there may be many such referrals which the MPS are not informed of. It states that ‘A girl who has already undergone FGM should not normally be subject to a child protection conference or registered unless additional child protection concerns exist. However, she should be offered counseling and medical help. Consideration must be given to any other female siblings at risk (see good practice guidelines for Children’s Social Care’) (paragraph 11.3.4. Safeguarding Children at Risk of Abuse Through Female Genital Mutilation. LSCB). This does not include an automatic referral to the MPS.
21. The MPS believes that this guidance hampers the ability to tackle FGM in London. FGM is child abuse, a serious crime and the child is entitled to redress as a victim of crime. The MPS believes that this guidance should be amended and that Social Care should
111 refer all such cases of a child being subjected to FGM to the MPS so that a joint decision can be considered as to the need for an investigation.
22. The child protection system - as set out in ‘Working Together to Safeguard Children’ (HM Government 2013) - is broadly the correct system for managing the risk to children from FGM. However, there is value in adapting the system to ensure the unique needs relating to FGM are met such as;
• Mandatory referrals from the NHS to Local Authorities (as per RCM guidance)
• Information sharing on all FGM victims from Social Care to the Police.
• Funded programmes promoting engagement and crime reporting within communities.
23. A significant lack of awareness across the public sector remains, evidenced by the RCM who state that ‘Professionals - such as primary school teachers, doctors, midwives and nurses - who are well placed to safeguard girls are often unaware that girls are at risk of FGM’ (p11). There is, therefore, a need, as per the RCM policy recommendations to develop a ‘whole systems approach’ for information collection, sharing and performance targets for doing so. The MPS supports this view as it is only when all information is consistently evaluated and shared that the MPS can effectively fulfill its role in safeguarding and investigating crime.
Barrier 3 - The nature of referrals.
24. The MPS has a duty to both undertake safeguarding activity with Social Care and investigate offences. Not all FGM related referrals to police amount to an offence. Most relate to a perceived risk that a child may be subjected to FGM at some future date. Where FGM is suspected or identified, it is the duty of Social Care to co-ordinate the most appropriate response for that child, which may never result in a charge.
25. An analysis of all 69 FGM referrals to the MPS in 2013 identifies that only 10 were recorded as an FGM offence. The remaining 59 cases related to a perceived risk of FGM which did not amount to a crime allegation. The reasons why these were not recorded as a crime allegations is because:
• The information related to a perceived risk. For example, where a third party such as a teacher had raised a concern that a child may be at risk of FGM because they were visiting Africa.
112 • Where a child has come to notice as having had FGM abroad prior to coming to the UK, so no offences are committed here.
• Where a mother has had FGM and a risk assessment has been undertaken on the family regarding whether the newborn is at risk.
• Where a child has returned to the UK from abroad and displayed signs of knowledge of FGM, which has started a safeguarding investigation.
26. It should be made clear that referrals into the MPS regarding FGM do not automatically provide an opportunity to investigate a crime allegation. The referral system allows a record of safeguarding risks and is not the same as crime reporting. However, what it ensures is that the MPS is able to robustly monitor all information relating to FGM to ensure a child focused safeguarding approach is taken in each case. In relation to these remaining 59 referrals which did not amount to a record of crime, the MPS undertook a review and safeguarding activity with other agencies into all 59 referrals.
27. Table 2 shows how the information provided to police has been categorized over the past four years.
Table 2
FGM referrals to MPS 2010-13 n
Recorded as an FGM crime 20
Referrals evaluated but not amounting to 122 a crime allegation
Classified / related to as another offence 19
Total 161
Arrests 12
CPS referrals or advice 10
28. The RCM identify three categories of risk to children regarding FGM;
113 • A girl at risk of FGM
• A girl who has undergone FGM
• A child born to a mother with FGM.
29. The key issue here is that two of the three risks require preventative safeguarding activity and are unlikely to result in charges. Only the child who has undergone FGM is likely to provide evidence which will result in a charge. The offence of planning such an act is much harder to prove therefore much of the police activity regarding FGM will never result in a charge, but may well result in a safeguarding outcome. Safeguarding is the optimal outcome as it prevents harm but yet this does not form part of current debates on the policing response to FGM. Both safeguarding and prosecutions should be seen as successful outcomes.
30. The NHS provides the greatest opportunity to identify women and children at risk from FGM, especially in maternity settings. The NHS also has a duty under s47 Children’s Act 1989 to make a safeguarding referral where a child has or is likely to suffer significant harm. Referrals rates reaching the police from the NHS are low and so the RCM has therefore made a policy recommendation that all women who present with FGM should be automatically referred to Social Care and the police.
Barrier 4 - Legal limitations
31. The Female Genital Mutilation Act 2003 makes it an offence under:
• Section 1 A UK or non UK national to mutilate female genitalia
• Section 2 To incite or assist a girl to mutilate herself within the UK.
• Section 3 To ‘aid, abet counsel or procure another person who is not a UK national to mutilate a girl’s genitalia outside the UK’.
32. Section 3 is only relevant if ‘it is done in relation to a United Kingdom national or permanent United Kingdom resident, and it would, if done by such a person, constitute an offence under section 1’.
33. There are some clear legal issues which impact on law enforcement.
114 Barrier 4 - Issue 1. Non-permanent residents.
34. The FGM Act is quite clear regarding UK based offending but under Section 3, where a child has undergone FGM abroad, yet the victim (the child) nor the suspects (parents) are ‘permanent UK residents’ then the offence is not made out. The MPS is currently investigating several such cases where this legal complexity exists.
35. The legislation only allows for UK residents to commit the offence of FGM abroad, therefore non permanent residents remain unaffected by the legislation. This provides a loophole for non UK residents to undertake FGM abroad, albeit other safeguarding interventions could take place.
Barrier 4 - Issue 2. Re-infibulation
36. There is a lack of clarity regarding ‘re-infibulation’ which the Act does not specifically prohibit. This provides a potential loophole whereby part of the mutilation process (the re-suturing) may not be offence (if it is undertaken after child birth, for example). The Act should be made clear in this regard.
Barrier 4 - Issue 3. Cosmetic surgery
37. Section 1 of the Act creates the offence. However, cosmetic surgery relating to removal of parts of the labia (‘excision’) or any other injection, piercing or other surgical intervention is often undertaken in the UK for cosmetic reasons despite clearly being an offence under Section 1.
38. The only defence to Section 1 is where the act is undertaken by a registered medical practitioner and it is ‘a surgical operation on a girl which is necessary for her physical or mental health, or a surgical operation on a girl who is in any stage of labour, or has just given birth, for purposes connected with the labour or birth’. (Section 1 FGM Act 2003, paragraph (2))
39. There is a perceived ‘double standard’ whereby there is a criminal focus on practicing communities yet within the Western world’s communities the ‘designer vagina’ private medical market flourishes. The offence is made out in both cases under the law.
115 Summary
40. The MPS’ view of matters that require urgent consideration if the impact on FGM is to be dramatically improved are;
41. The FGM Act 2003 should be reviewed in order to remove the restrictions that Section 3 put in place regarding only permanent UK residents being able to commit the offence of arranging FGM abroad. The issue of re-infibulation and cosmetic surgery should be reviewed.
41. The MPS supports the RCM’s concept of developing a ‘whole system approach’ from prevention and identification to mandatory referrals. In particular, the MPS recommends that Social Care amends the current LSCB policy ‘Safeguarding Children at Risk of Abuse through Female Genital Mutilation’ to ensure all instances of FGM are reported to the MPS.
40. That a multi-agency policy be developed to enable a sustained outreach worker programme within London which develops engagement between the MPS and affected practicing communities and allows for greater crime reporting.
References:
FORWARD A Statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales. (2007)
HM Government Working Together to Safeguard Children (2013)
LSCB Safeguarding Children at Risk of Abuse Through Female Genital Mutilation (current but undated)
Royal College of Midwives Tackling FGM in the UK (2013)
UNICEF UNFPA and UNICEF Annual Report (2012)
Assistant Commissioner Mark Rowley Metropolitan Police Service
February 2014
116 Written evidence submitted by the Tackling FGM Initiative
“When I was a little girl I wanted to have adventures and explore and I had dreams about the woman I would become. Now I have become FGM.”
FGM survivor from Sierra Leone
The Tackling FGM Initiative is a UK-wide network of grass roots organisations working to end FGM funded by Trust for London, Rosa Fund, Comic Relief and the Esmee Fairbairn Foundation. The Initiative is supported by an Advisory Group that includes Equality Now, Forward and Daughters of Eve. The Initiative’s work is externally evaluated by Options Consultancy. The report is compiled by the Initiative’s Grants and Development Manager, Hekate Papadaki, and has been prepared by:
• Direct consultation with the Initiative organisations. • Reviewing and collating individual reports from Birmingham and Solihull Women’s Aid, the Manor Gardens Welfare Trust, Somali Development Services and Granby Somali Women’s Group. • Consultation with the Manor Gardens FGM Forum, consisting of over 40 voluntary and statutory sector organisation working to end FGM, including the NSPCC, IMKAAN, IKWRO, Islington Council, Lambeth Council and many others • Drawing from research findings from Options Consultancy, the Initiative’s external evaluators • Feedback from the Initiative’s Advisory Group.
How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
As evidenced by the existing lack of prosecutions, the current legislative framework is not effective. In fact, having a specialist FGM Act reinforces the attitudes by frontline professionals of not treating FGM as any other form of child abuse.
Below we have broken down the reasons the current legislative framework is ineffective in barriers for affected communities and barriers for professionals:
Barriers for Affected Communities:
1. There is widespread mistrust of social services and the police amongst affected communities. Even if community members wish to report a concern, they feel that a) social services will not take up their concerns because it won’t meet their threshold of risk, b) they are worried that social services will over react. For example, our projects report a number of cases in which social services proceeded to remove children from families (including male children) following reported concerns, without conducting any investigations or assessments.
2. Community members worry that their identity will be revealed if they report concerns and that they will suffer retributions as a result. It is widely unknown that it is possible to report information anonymously or that it is possible to pass on intelligence to Crimestoppers without having evidence.
117
3. Affected communities still view FGM as a cultural norm and a way to preserve women’s honour, rather than a crime. This is particularly true for ‘lesser’ types of FGM, including Type 1, Type 2 and Type 4 (frequently referred to as 'sunna’). Evidence from our work indicates widespread condemnation of Type 3 FGM, but persistent support for other forms, coupled with the belief that ‘sunna’ is much harder to detect on children. Comments such as ‘who’s going to know if we take the girls back to do sunna’ are often heard within affected communities.
4. Despite awareness raising efforts, a significant number of people from affected communities are not aware of the FGM Act, or believe that it does not extend to ‘sunna’, that it does not apply when children are taken overseas to perform FGM or believe that it only applies to the cutters and not the ones organising it. Lack of awareness of the law is particularly true amongst new arrivals to the UK.
Barriers for frontline professionals:
1. The fact that the prohibition of FGM is not included in the Children Act and that there is a separate act on FGM, reinforces the widespread belief that FGM is cultural and not child abuse.
2. The FGM Act expects children who have undergone FGM to testify against the perpetrators. This is not feasible for a number of reasons: a) children do not want to be responsible for their parents’ imprisonment, b) the experience of going through trial would be very traumatic, c) FGM can be perpetrated to children of any age, including babies, who would be unable to testify. In fact, anecdotal evidence suggests that parents might choose to have their children undergo FGM at a much younger age, to ensure they would be unable to testify. Other acts, such as the Children Act or the Offences Against the Person Act, should be considered to prosecute perpetrators.
3. Frontline professionals are not universally trained on recognising the risks of FGM or understanding when FGM has taken place. This is true for all frontline professionals including health, education and safeguarding professionals. FGM is not currently part of statutory child protection training, which significantly hinders professionals’ understanding of how to recognise and respond to it. For example, it is very common for teachers or doctors who undertake training from our community projects to tell us that they retrospectively recognise signs of FGM on children they have been in contact with in the past.
4. A number of professionals shy away from approaching the subject of FGM for fear of being branded ‘racist’. For example, women who have undergone Type 3 regularly report to us that they are never asked about what has happened to them during medical checks. Equally, education professionals refuse to display awareness raising materials in schools for fear of ‘offending’. During the training sessions delivered by our projects, professionals regularly ask for practical advice on how to broach the subject without offending community members.
118 5. Social service professionals are not trained to conduct risk assessments on FGM. They regularly refer cases reported to them back to our community groups and ask them to assess the risk, or refuse to take on referrals because they don’t meet their risk thresholds. On the other end of the spectrum, some social service professionals can over-react when dealing with cases of concern, because they are not aware of how to assess risk. Social service professionals regularly tell us that dealing with FGM is not their direct responsibility.
6. The FGM Act does not currently protect children who are not British citizens. The extratorriality of the Act needs to be strengthened.
7. Anecdotal evidence from our community groups suggests that FGM takes place primarily overseas in countries with no FGM legislation (e.g. Dubai). This is especially true in recent years when a large media campaign coupled with a strong grass-roots awareness raising movement makes potential perpetrators wary of practicing FGM in the UK. However, the fact that the Metropolitan Police is currently focussing on prosecuting cutters rather than parents (as we are constantly told) means that there would be no incentive to follow up cases overseas – the FGM Act does not cover foreign nationals.
Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
Groups at risk:
All community members from countries with a high prevalence of FGM overseas should be considered to be at risk. Community members that are more settled in the UK are less at risk – our research suggests that the longer a community member has stayed in the UK the less likely they are to support FGM. New arrivals from countries with high prevalence of FGM should be considered to be at the highest risk. At the same time, new arrivals could potentially pose risk to more settled family members. [MAYBE LIST THE HIGHEST PREVALENCE POPULATIONS IN THE UK HERE?]
The level of awareness of the negative consequences of FGM differs significantly amongst communities. For example, there has been ongoing dialogue on FGM within the Somali community for a number of years and as a result support for the practice is waning, at least for settled community members. However, there are a number of other communities where FGM is considered taboo or not acknowledged as a problem. This is particularly true for Middle Eastern communities, and especially Sunni Kurds from Iraq and Iran, as well as Western and Central African communities.
Despite the above, any girl born to a family where one or both of her parents come from a country with FGM prevalence should be considered to be at risk. Feedback from the African Well Woman Clinics suggests that even girls born in other European countries can be subjected to FGM (if one of their parents comes from and affected community) as well as British women with spouses from affected communities.
Barriers to identification and prevention:
119 The Tackling FGM Special Initiative projects regularly provide training for frontline professionals and have highlighted the following barriers to their ability to identify and intervene:
. Lack of knowledge of the practice, its severity and the potential risk to girls / young women that they have contact with
. Lack of confidence in appropriately raising the issue with a child or a family
. Lack of clarity regarding appropriate steps and referral processes if they have concerns
. Lack of risk assessment protocols for social services
. Lack of mandatory training: currently professionals receive training on an ad-hoc basis, dependent on individuals within an organisation taking a pro- active interest in the topic or upon the presence of a grass-roots organisation exerting pressure upon them to receive training
The following are barriers on identification and prevention at a community level:
. Lack of dialogue between men and women about the practice – some men know very little about what it involves and some women believe that men require it. Young men frequently assume that it no longer takes place, at the same time as young women from their communities are affected.
. The topic is surrounded by silence – young women don’t feel able to talk to their mothers, family members or even their friends about it. In some cases they don’t know what type they have had done or whether they have had it at all and don’t feel able to ask their parents.
. Where people believe it is a religious obligation they do not feel able to challenge it. There is therefore a need to engage and support religious leaders to provide a public and unequivocal message on FGM.
. Statutory and community services should examine how they can best support parents / siblings who are under pressure from extended families / wider community to perform FGM but do not want to go ahead.
“the reason why I have decided to leave my daughter alone is because I asked a woman from the mosque who teaches me Quran. She said that it was not written in the book and this practice was attached to my culture and traditions not the religion. I told my mother this and she became very angry and said stop listening to people who know nothing and she still shouts at me about this issue and says I will take your daughter back home myself and get it done but I know she will never, as I told her I would tell the imam at the mosque and she got scared but when I said I will tell the police she was like I don’t care”. Service User, Granby Somali Women’s Group
What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
o Police . Enforcement,
120 . Community liaison, breaking down barriers between communities and Police. It is particularly important to work closely with grass-roots community organisations to build ties with affected communities . Awareness raising in partnership with other agencies in relation to the legal status and implications of FGM. . Working with partner agencies to improve current legislation and input on future amendments to legislation especially around police role within the new defined frameworks. . Gathering intelligence – undercover police officers from affected communities could help, especially if they operate in areas with high prevalence of new arrivals from FGM practicing countries. Also, working closely with grass-roots community organizations to spread the message that information can be given to the police anonymously through Crimestoppers. . Prevention campaigns in flights to countries with high FGM prevalence during holiday seasons. These operations are particularly successful when undertaken in partnership with grass-roots organizations and community workers carry them out alongside police officers.
Education
Identifying girls at risk Reporting Working with third sector organizations to educate parents on the risks of FGM Working with third sector organizations to educate students on the risks of FGM and how to protect themselves and fellow students
Social Care Professionals
“if they have a child with bruises they would rather focus on that than on a child with FGM done 5 years ago”. Options UK Evaluation of Phase I of Tackling FGM Initiative.
Social care professionals have a duty of care for all children at risk of FGM. However, current risk thresholds need to be reviewed and specified as they are too high and prevent follow up of referrals.
It is crucial to draft clear risk assessment guidelines, clarifying what constitutes ‘concern’ and ‘suspicion’ with regards to FGM and specifying the course of action for each case.
Professionals should visit families at risk and raise awareness of the law. The practice of signing agreements to not perform FGM with families at risk has been very effective, especially if families are notified of the purpose of upcoming visits in advance.
121 Professionals should work closely with grass-roots community groups to gain the trust of affected communities. In areas where social workers visit families at risk alongside community workers, acceptance from community members has risen and relationships have improved.
Third Sector
Develop community awareness raising programmes in close partnership with health, education and safeguarding professionals. The responsibility for awareness raising programmes should lie with grass roots organisations as they are trusted by affected communities and abandonment messages are more likely to be accepted from them. However, this should not continue happening on an ad hoc basis with limited funding from trust funders. Awareness-raising should be mainstreamed with funding from local government. Equally, it’s important to develop standards for community awareness raising programmes to ensure consistency in messaging, follow up and support.
Supporting the police with collecting intelligence. This includes informing community members about routes for reporting information anonymously as well as working closely with the police and social services to communicate information. There is scope for grass roots community organisations to act as reporting centres where members of the community can report any FGM incidents in an environment and to people who they are familiar and comfortable with.
Working with social services to conduct visits to families at risk and inform them about the law as well as participating in safeguarding case conferences. This is both to provide vital cultural information as well as to improve cooperation between affected communities and social services. A number of the Tackling FGM Special Initiative projects work closely with social services (e.g. in Islington, Bolton, Birmingham and Cardiff). For example, an effective practice involves preventative visits to families at risk (e.g. new arrivals from affected communities, families with female children where the mother has had FGM etc) to inform them about the law and ask them to sign an agreement confirming they are aware of the legislation and will not be performing FGM.
Providing consultation during the development of awareness raising campaigns and publicity material to ensure they are targeted, effective and culturally sensitive.
122 Training and supporting community role models to spread abandonment messages amongst their communities.
Participating in the training of frontline professionals to provide cultural context and enforce protection messages. A number of the Tackling FGM Special Initiative projects provide training for frontline professionals including the police, social services and education professionals. Training is particularly effective when survivors give their perspective on FGM and help professionals understand how to start conversations with families at risk and identify children at risk, as well as how to be culturally sensitive without compromising safeguarding responsibilities. Although training of all professionals should be mainstreamed, the participation of survivors in training delivery would significantly improve quality and effectiveness.
Finally, third sector organisations have to support individuals affected by FGM. Due to the nature of the crime, survivors experience strong feelings of shame and isolation. The provision of safe spaces where women can share similar experiences without being judged is vital and cannot be provided by mainstream mental health support services that are neither culturally appropriate nor trusted by affected communities.
How can the systems for collecting and sharing information on FGM be improved?
We currently lack an inter-ministerial, national action plan that clarifies referral pathways, recording procedures and agency responsibilities. The Department of Health has led the way in standardising data collection by healthcare professionals. However, there are currently no referral pathways in place to ensure that this information will be communicated so that it is possible to identify children at risk and ensure they are monitored by all professionals who come in contact with them throughout their lives, including health visitors, GPs, teachers, and social work professionals.
Social work professionals are unclear about what to do when they receive information about girls at risk and regularly pass on the responsibility for their protection to community organisations. A clear risk assessment framework needs to be developed for FGM. Currently, both third sector organisations and other statutory professionals are reluctant to work with social services as they do not understand how to respond to cases of risk.
The Intercollegiate Recommendations on FGM for health and social care professionals need to be consulted when developing referral pathways.
How effective are existing efforts to raise awareness of FGM?
123
Currently, awareness-raising efforts rely entirely on the presence and available funding of grass-roots community organisations. However, grass-roots organisations have limited funding and reach. For example, feedback from the Tackling FGM Special Initiative projects suggest there is still considerable lack of knowledge of legislation on FGM, lack of understanding on how to pass on information confidentially to the police and lack of knowledge of available support services such as African Well Woman Clinics, the health passport or the NSPCC helpine.
Community media need to be utilised in an on-going basis to ensure knowledge of the law, referral methods and available support services. Feedback from our projects reveals that utilising community media significantly increases the numbers of community members accessing services.
Information about the law needs to be provided to every new arrival from a community where FGM is practiced upon entering the country. Health visitors should also pass on information about the law, consequences of FGM and available support services to every family from an affected community that has a girl child.
The helpline needs to be more widely-publicised, in particular it needs to be targeted to girls who may be at risk (currently being used by professionals). Schools could be instrumental in promoting the helpline, for example by placing stickers with the number for it in students’ toilets.
Feedback from the Tackling FGM Special Initiative projects indicates that the Health Passports are well-received and community members are positive that they provide an “official statement” against FGM. However it is not clear to what extent they are taken abroad by girls who may be at risk. There need to be clear structures in place for girls to seek help if they are abroad and think they are at risk of FGM, as is currently available for those at risk of forced marriage.
How can the available support and services be improved for women and girls in the UK who have suffered FGM?
The Tackling FGM Special Initiatives has just completed an FOI request to Care Commissioning Groups around the UK about the services which been commissioned to support survivors. The results indicate that there are currently only 17 African Well Woman Clinics and only one specialist counselling service around the country. These services are grossly inadequate.
Women who wish to access support services in secret in areas where no such services exist are consistently failed. At the same time, specialist clinics do not allow girls under 18 to self refer for deinfibulation procedures. This has to be reviewed immediately, as girls who have undergone FGM are unlikely to be referred to specialist clinics by their parents.
There is currently a failure to recognise that mental health and clinical support services are vital in driving prevention efforts. However, it is in these settings that survivors begin to recognise the negative consequences FGM has had on them and can be supported to break the cycle of violence.
124 Written evidence submitted by Hilary Burrage
Introduction Hilary Burrage BSc (Soc)(Hons), MSc, PGCE, FRSA is a consultant sociologist currently writing a book, Eradicating Female Genital Mutilation: a UK perspective. This submission represents solely her own observations and opinions.
1. Focus of this submission
This submission focuses on potential obstacles, uncertainties and issues for further research around the operation of current UK legislation on FGM, which to date - and despite many thousands of British girls and women having been harmed - has never secured a prosecution. In so doing I will consider human agency and the perceptions which various professionals and others may have which block progress. I will also suggest some of the possible ways in which UK legislation on FGM might be more effectively enforced.
2. Potential obstacles to securing FGM prosecutions
I. Estimates suggest that many thousands of girls (even baby girls) and women in the UK undergo FGM every year. Yet to date - some three decades after the introduction of specific legislation - not a single conviction relating to FGM has been achieved in the UK. It is therefore self-evident that there are problems either with the legislation itself, and / or with the way it has (not) been implemented.
II. In my view (but as a non-lawyer) a. The legislation as it stands covers most, but not all, the matters to hand; b. The most pressing omission from current legislation is relates to instances where non- nationals are taken abroad to be mutilated; and c. Older legislation, for instance on grievous bodily harm and on conspiracy to conduct a crime, would cover a significant proportion of the aspects not attended to in [1] above.
III. Nonetheless, none of the legislation has so far been tested in court. This is probably more because of human agency issues, rather than because the law itself does not make successful prosecution possible.
IV. The law as it stands does (with some small limitations which require attention) provide for criminal action, but the way the legislation has been perceived has resulted in a very serious failure to uphold that law. It is these failures of human agency to secure convictions and thereby the effective rule of law which I address in this submission.
V. The following aspects of law enforcement to prevent and prosecute female genital mutilation will be considered:
125
• Failures to investigate • Pathways for reporting • Mandatory reporting • Inspection of children • Professional reputational concerns • Concerns about confidentiality • Concerns about ‘culture’ • Concerns for children at risk • Efficacy of legal sanctions
Specifics of obstacles to upholding the law on FGM
3. FAILURES TO INVESTIGATE FGM
I. FGM is a covert activity in the UK. It has throughout the ages been surrounded in mystery wherever it occurs, and to that has in contemporary times been added the necessity, if it is to be performed, of secrecy to avoid the law.
II. This is however not a situation unique to FGM. Very few criminal activities are conducted overtly, but that has not prevented their being detected, if the will is there.
III. We need to understand why the police and prosecutors have not until now given resources and adequate thought to the detection of FGM, and – in some ways even more crucially – to the prevention of this very serious crime.
IV. Amongst those reasons may be the lack of police decision makers with personal experience of communities away from the mainstream (the majority of police officers, especially in the higher ranks, continue to be white men). For most police officers issues concerning female genitalia may be uncomfortable; and they may also lack awareness of, or any insights into, the ‘signals’ which exist in minority communities that FGM is about to occur.
V. It has been convenient to maintain that no-one reports FGM to the authorities; but there again almost no-one reports many other crimes for which detection is necessary. The passive inertia of law enforcement agents has left FGM ‘cutters’ to conduct their work unimpeded by its illegality.
4. PATHWAYS TO REPORTING
I. There is no clear reporting mechanism for FGM which applies across the board.
126 II. Child safeguarding pathways in Britain currently vary, depending on who (from which profession) reports them. They are also contingent on effective mechanisms at the local, even micro, levels. Many different telephone numbers and individual professionals may be involved even at the local level, and these may change over time. We need nationally co- ordinated, unified pathways, between all agencies and the public - not ‘just’ Childline, the NSPCC FGM line, the local social services line, the 999 number, the GP’s surgery number (or on-call?) and whatever else....
III. Under the current system, many thousands of practitioners in a range of agencies would need to be trained to a high level of operational competence to deal well with safeguarding children, whether because of the risk of FGM or any other type of child abuse such as general cruelty, or for instance sexual violation.
IV. This ‘system’ compares very poorly with other countries such as France, where all concerns about risk of FGM and evidence of harm, must be reported to specially trained investigators, and where also a child at risk is allocated her own safeguarding professional (rather like a guardian ad litem) whose role is to decide on the child’s behalf, apart from that of anyone else, what actions are in the best interests of the child and her safety.
V. A single, national central system (and telephone number, like, or as part of, the 999 one) is required for rapid and effective safeguarding, with decisions and referrals cascaded down to trained and named local practitioners. Ideally there would be a national central reporting point for everyone who is concerned about child abuse, predators, FGM specifically, grooming, child ‘marriage’ etc (24/7 with fully trained operators) and this would feed down for immediate action (if required) through the Local Safeguarding Children Boards, which are required to liaise with police, schools, health, social services etc.
VI. This system would also enable a national picture of likely abuse to be created – a system which might have helped to identify much sooner for instance the ‘grooming’ of girls in various cities. This would also offer a degree of joined-up protection to girls at risk of FGM, who may live in families where frequent moves are likely and a localised protection system is not adequate to ensure their safety.
5. MANDATORY REPORTING
I. The case for mandatory reporting by professionals of FGM and suspected risk of FGM is very strong.
II. It is obvious the current requirement that suspected abuse be reported is widely ignored and has failed many thousands of girls (and, in other examples such as school abuse, boys as well).
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III. Appended below are statements by Government Ministers and the relevant Royal Colleges that concerns about girls at risk of FGM are reported. The disparity between estimated numbers of girls at risk / harmed (thousands annually), and the numbers of reports (tens per annum) offers overwhelming evidence that these claims are generally hollow.
IV. Not only however would formal, legally mandated reporting provide more protection for children, it would also help professionals themselves.
V. A nationally established ‘traffic lights’ system is necessary for all FGM (and other child abuse) reporting, such as that used in eg some NHS organisations, where assessment of risk and subsequent actions is determined by fully trained, named practitioners. This would remove the onus on teachers, nurses and others themselves to decide whether the level of evidence warranted further action – thereby making the process of reporting less daunting and uncertain for those who report and more secure and effective for those thought to be at risk.
VI. It is important in respect of mandatory reporting to be clear that recording the observed incidence of FGM in hospital settings as will now be required (hospitals only; not elsewhere.....) is very different from reporting concerns about risk to girls who have not as yet undergone mutilation. The former is very important for future policy and action; the latter is critical to individual children’s safety.
6. INSPECTION OF CHILDREN
I. Routine full medical inspection of all small children, whatever their background, boys and girls alike, would serve several important roles. Inspection of ‘only’ certain groups of children would be unacceptable.
II. If parents refuse permission for their children to be inspected, this should be noted.
III. Inspection would help to ensure the provision of any necessary care in the case of children who are found to have any medical condition, whether genital or otherwise.
IV. It would provide a baseline to establish that a child has normal anatomical / genital features.
V. It would serve to remind parents that any non-clinical bodily intervention or harm, genital or otherwise, is illegal.
128 VI. It would provide an excellent opportunity to ensure that parents or guardians understand the seriousness and probable legal / social outcomes of any attempt to harm a child by FGM or other violent act.
VII. In the fairly recent past medical inspection was a duty of school nurses and doctors anyway. The prudery which underlies current claims that ‘parents will never agree to this’ is part of the generic problem. It might be thought there is not a massive difference in perceptions (though of course there is an infinite one in respect of action) between such claims, which sexualise children’s bodies by default, and the belief that little girls ‘need’ to be desexualised by FGM - even before adulthood - to stay ‘pure’.
7. PROFESSIONAL REPUTATIONAL CONCERNS
I. A frequent concern of professionals, such as teachers, who have non-medical responsibility for children’s safety, is that any reference by them to little girls’ bodies will be misinterpreted as salacious. It is important to counter this apprehension, so that all suspected risk can be reported immediately and as accurately as possible.
II. Mandatory reporting and standardised, confidential routines for sharing concerns will help enormously in this respect. If a trained person away from the immediate environment takes responsibility for actions which follow any report, teachers and others will feel less worried that they may be mistaken (and unfair to parents / families) or misinterpreted in their suspicions.
8. CONCERNS ABOUT CONFIDENTIALITY
I. Whilst clarity about the parameters of medical confidentiality can be expected amongst senior members of the clinical professions, it seems likely that this is not always the case amongst those who work directly at the client / patient interface.
II. To give one example, midwives may believe, often correctly in the case of patients in marginalised communities, that they are the only professionals in whom their clients have confidence. Reporting actual FGM or suspicions that children (already born, or soon to be born) may be at risk may feel like a gross breach of trust in such circumstances. The direct patient-client relationship is the focus in such circumstances, and other considerations may be put aside: My client depends on me as her advocate. Surely my caring patient wouldn’t harm her child?
III. Once more, mandatory reporting will largely overcome this superficially understandable, but legally impermissible, position – especially if that reporting is underpinned by serious and
129 thorough law enforcement to ensure that FGM does not thereafter go ‘underground’, which is another repeated concern of midwives and similar clinicians.
9. CONCERNS ABOUT ‘CULTURE’
I. It is said that teachers and others fail to report their concerns about a risk of FGM because of inappropriate concerns about ‘culture’; they are said to be fearful that they will be labelled racist if they report, and they want to appear to ‘respect’ the communities which they serve.
II. Whilst this concern may have had (also impermissible) traction at one time, a more likely current concern is that reporting will encourage racism in others, at a time when the general populace seems to be increasingly engaged in worries about ‘foreigners’. It is important therefore that the focus of the law remains unremittingly on the welfare of children, not on their community beliefs or the colour of their skin.
III. All politicians and community leaders have a role to play in ensuring that inappropriate commentary on ‘cultural relativism’ and ‘racism’ is put aside in the interests of children’s safety.
10. CONCERNS ABOUT CHILDREN AT RISK
I. Many professionals have a concern that reporting FGM or a suspected risk that it may occur will break up families ; by default they may believe that children are more at risk if their parents or guardians are intercepted and perhaps punished, than they are from FGM and its consequences.
II. This misplaced concern is best addressed directly: if children (girls themselves, big brothers and sisters, cousins) and / or other relatives report FGM and thereby stop it happening, they will also have prevented parent/s from committing a very serious crime. And the same applies to professionals with such concerns.
III. A similar concern is expressed by some campaigners themselves from minority ethnic communities. They point to the contradictions when other similar campaigners demand action now, but still want to ‘protect’ their own parents, who inflicted this harm on them in earlier years.
IV. Again, a proper reporting system with an independent, trained official to decide how to ensure the safety of girls (whether they are suspected or real victims) is the best way to ensure that those with on-the-ground knowledge will share it confidently and promptly.
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V. Ultimately however, whatever the situation, everyone must understand that FGM is never to be tolerated. It ruins, and sometimes costs, lives.
11. EFFICACY OF LEGAL SANCTIONS
I. FGM is not an opportunistic crime. It always requires preparation and planning; inevitably it involves several people and probably quite a lot of money.
II. It is reasonable therefore to suppose that legal interventions to stop FGM, accompanied (where appropriate to the specific case) by full media coverage of such intervention, will have a significant impact on the likelihood of it occurring.
III. Further, whilst generically (misplaced) claims might be made that FGM is an ‘act of love’, this is not always so. It may be inflicted to punish or control the behaviour of ‘difficult’ girls – quite possibly in the context of modern Britain, especially those who wish to lead modern, independent lives with full autonomy for their decisions and futures? Perhaps there is a spectrum of behaviour here which also includes ‘honour’ killings. Enforcing girls’ human rights is critical.
IV. Rationales and apologies for FGM are however immaterial. It is a violent and cruel, sometimes lethal, crime and must unerringly be seen as such.
Conclusion
1. Legal action alone will not eradicate female genital mutilation in the UK or anywhere else. Education and genuine prospects of bright futures for the girls whose lives it might otherwise ruin are also absolutely essential, if FGM is to become a thing of the past.
2. This does not in any way however remove the imperative to bring the full force of the law into play to stop this appalling crime.
NOTE
The exploration above of contributory factors in failing to uphold the law on FGM is set within the context of the Guardian article 10 reasons why our FGM law has failed – and 10 ways to improve it (7 February 2014) by Dexter Dias, Felicity Gerry and myself, Hilary Burrage. Also of relevance is this post which I wrote on 23 November 2012: The Crown Prosecution Service Finally Responds To The Horrors Of Female Genital Mutilation In The UK.
131 APPENDIX ON REPORTING FGM
1. Female Genital Mutilation Question Asked by Lord Taylor of Warwick Daily Hansard 29 Jan 2014 : Column WA229 To ask Her Majesty s Government what plans they have to deal with hospitals which are failing to report female genital mutilation.[HL4765] The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con): It is the responsibility of National Health Service trusts to ensure that their staff follow correct safeguarding procedures. NHS staff have a legal obligation to safeguard children, so whenever they identify a child who may be at risk of *female genital mutilation* (FGM) or who has already been subjected to FGM, they must always respond by involving the appropriate authorities as set out in the in the Female Genital Mutilation Multi-Agency Practice Guidelines (2011) **. http://www.publications.parliament.uk/pa/ld201314/ldhansrd/text/140129w0001.htm
2. Female genital mutilation: multi-agency practice guidelines
3. The RCM Intercollegiate position: http://www.rcm.org.uk/college/policy-practice/joint-statements-and-reports/ 2.6.2 Girls who have undergone FGM In cases where girls are identified as having undergone FGM, a referral to children’s services and the police must be made. All health, education and social care professionals have a statutory duty to report any suspected case of child maltreatment, including FGM.
~ ~ ~ ~ ~
Hilary Burrage BSc (Soc)(Hons), MSc, PGCE, FRSA is a consultant sociologist currently writing a book, Eradicating Female Genital Mutilation: a UK perspective. She has been a Senior Lecturer in Health and Social Care, a Research Associate in Social Medicine (teenage pregnancy), and is author of the Chapter on Health Education in Dufour, B. (ed.) The New Social Curriculum: A Guide to Cross- curricular Issues, Cambridge University Press (1989). Hilary is a qualified teacher, has been a Non- Executive Director of an NHS Trust, and has worked as a social worker and as a consultant for Youth Service and Sure Start programmes. More recently, she has been advising The Guardian on their 2014 campaign to #EndFGM and she is an advisory board member of the REPLACE2 European programme to stop FGM. Hilary has a professional website, at www.hilaryburrage.com.
132 Written evidence submitted by Rights of Women and Asylum Aid
Rights of Women
1. Rights of Women works to secure justice, equality and respect for all women. Our mission is to advise, educate and empower women by:
• Providing women with free, confidential legal advice by specialist women solicitors and barristers. • Enabling women to understand and benefit from their legal rights through accessible and timely publications and training. • Campaigning to ensure that women’s voices are heard and law and policy meets all women’s needs.
Rights of Women specialises in supporting women who are experiencing or are at risk of experiencing, gender-based violence, including domestic and sexual violence. We support other disadvantaged and vulnerable women including Black, Minority Ethnic, Refugee and asylum-seeking women (BMER women), women involved in the criminal justice system (as victims and/or offenders) and socially excluded women. By offering a range of services including specialist telephone legal advice lines, legal information and training for professionals we aim to increase women’s understanding of their legal rights and improve their access to justice enabling them to live free from violence and make informed, safe, choices about their own and their families’ lives.
2. Rights of Women operates three specialist legal advice lines on family, criminal and immigration law. The advice lines are staffed by women solicitors and barristers who have experience in the relevant areas of law; advisors may be either staff or volunteers. Advice is free and confidential and available regardless of the financial resources or immigration status of the caller. In 2012 we advised 1431 women.
Asylum Aid
3. Asylum Aid is an independent, national charity working to secure protection for people seeking refuge in the UK from persecution and human rights abuses abroad. We provide free legal advice and representation to the most vulnerable and excluded asylum seekers, and lobby and campaign for an asylum system based on inviolable human rights principles.
4. The Women’s Project at Asylum Aid strives to obtain protection, respect and security for women seeking asylum in the UK by providing specialist advice and research and campaigning on the rights of women seeking asylum. Five years ago Asylum Aid initiated the Charter of Rights of Women Seeking Asylum which brings together nearly 350 organisations in support of these rights.
133
This evidence
5. Rights of Women and Asylum Aid wish to draw the Committee’s attention to two separate, but related, areas of concern:
a. The lacuna in the current criminal law on FGM. b. The failure of the Home Office to meet the needs of asylum-seeking women who are at risk of, or who have experienced, FGM.
6. It is submitted that these failures stem from the development of a flawed and discriminatory response to FGM that seeks to differentiate between actual and potential victims on the grounds of their immigration status.
Background
7. FGM is defined by the World Health Organisation as:
“all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons.”1
8. FGM may take a number of forms ranging from procedures that involve pricking or piercing the clitoris and/or labia to infibulation (which involves the complete removal of the clitoris, the labia minora, some or all of the labia majora and then the two sides of the vulva being sewn together leaving only a very small opening for the passage or urine and menstrual flow).
9. The World Health Organisation estimates that the number of girls and women who have undergone FGM is between 100 and 140 million and that each year 3 million girls are at risk of undergoing FGM. FGM is practised in more than 28 countries in Africa and in some countries in Asia and the Middle East. The countries which have highest prevalence of FGM are Burkina Faso, Djibouti, Egypt, Eritrea, Ethiopia, The Gambia, Guinea-Conakry, Mali, Sierra Leone, Somalia and Sudan.2 A statistical analysis conducted in 2006 by FORWARD (the Foundation for Women's Health, Research and Development), the Department of Midwifery at City University and the Department of Health indicates that there are 23,000 girls in England and Wales under 15 years of age who are at risk of FGM.3
1 WHO factsheet on asylum, number 241, updated January 2013 www.who.int/mediacentre/factsheets/fs241/en/. 2 Female Genital Mutilation: Treating the Tears, Haseena Lockhat Middlesex University Press, 2004. 3 A Statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales.pdf (.pdf 222.2 KB) FORWARD 2007.
134 10. In Rights of Women’s experience, women and girls who have either undergone FGM or are at risk of having FGM carried out: • have originally come from FGM practising communities in other countries but are in the UK as refugees, to work, study or marry; or are, • British citizens or residents whose parents or grandparents are from FGM practising communities.
11. Rights of Women and Asylum Aid’s position on FGM is informed by international human rights law which universally condemns it as a form of violence against women that must be responded to with due diligence without discrimination:
a. The Universal Declaration of Human Rights 1948 states that “all human beings are born free and equal in dignity and rights”. It protects the right to security of person and the right not to be subjected to cruel inhuman or degrading treatment.
b. Article 2 of the UN Declaration of the Elimination of Violence against Women 1993 defines FGM as a form of violence against women while Article 5 requires states to work towards: "the elimination of prejudices and customary and all other practices which are based on the idea of the inferiority or the superiority of either of the sexes".
c. Article 5 of the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa 2005 requires states to prohibit traditional practices that are harmful to women, including FGM, as well as to take all necessary measures, legal and otherwise to protect women from FGM.
d. UN Convention on the Rights of the Child 1993 requires states to take all necessary measures to abolish traditional practices that are harmful to children’s health. Similar requirements are in the African Charter on the Rights and Welfare of the Child 1990.
The criminal law on FGM in England and Wales
12. The Committee will be aware that the Female Genital Mutilation Act 2003 (which came into force on 3rd March 2004) makes it a criminal offence to:
a. Excise, infibulate or otherwise mutilate the whole or any part of a girl or woman’s labia majora, labia minora or clitoris. b. Aid, abet, counsel or procure a girl to mutilate her own genitalia; or c. Aid, abet, counsel or procure a non-UK person to mutilate a UK national’s or permanent resident’s genitalia outside of the UK.
135 13. The Female Genital Mutilation Act 2003 (the Act) applies to England and Wales; Scotland has its own legislation on FGM (the Prohibition of FGM (Scotland) Act 2005). In its call for evidence the Rt Hon Keith Vaz MP, Chair of the Committee, rightly expressed concern that no one has yet been prosecuted under this legislation (although at the time of writing it appears that a prosecution(s) may be immanent). We would contrast this position with that of other jurisdictions, notably France and Sweden, when prosecutions have successfully taken place. 4
14. The offences created by the Act extend to actions done outside of the UK by a UK national or permanent UK resident. It is therefore an offence to carry out FGM on any girl within England and Wales but it is also an offence to take a British child or a permanent resident out of England and Wales to have FGM carried out. The person will have committed an offence under the law of England and Wales even if FGM is not an offence in the country where it was performed. The legislation uses the term “girl” throughout but actually extends to protect women (over 18 year olds).
15. While the Act makes it an offence to carry out FGM in England and Wales or encourage a girl to mutilate her own genitalia, the extra-territorial provisions of the legislation only applies to girls who are British or permanent residents. The Act does not, therefore, fully protect children who are non-permanent residents. This includes the children of those who are in the UK lawfully, such as the children of students or workers, as well as the children of those who might be unlawfully present or have temporary admission.
16. Rights of Women and Asylum Aid submit that this difference in treatment is unlawful discrimination that violates the principle of equal protection of the law. We remind Committee members that reservations to the UN Conventions on the Elimination of Discrimination Against Women and on the Rights of the Child that related to persons under immigration control have been removed. Other relevant human rights law, such as Article 3 of the European Convention on Human Rights 1950 (the right to be free from torture, inhuman or other degrading treatment) are also engaged and must be secured without discrimination for everyone within the jurisdiction.
17. Legislation has a normative value. Any law that fails to protect all women and girls from a potentially life-threatening form of gender-based violence reinforces the position of those who view women and girls’ bodies (and particularly the bodies of those who face multiple forms of discrimination, such as on the grounds of race or immigration status) as not worthy of protection.
4 For example, Women’s Asylum News issue number 62 July / August 2006 reported on a Swedish case where a man was jailed for 4 years and ordered to pay his 13 year old daughter damages of £26,000 for forcing her to undergo FGM when she was 13. See also http://www.theguardian.com/society/2014/feb/10/france-tough-stance-female-genital-mutilation-fgm.
136 18. We are concerned that this discriminatory ‘double standard’ also operates as a barrier to potential prosecutions by causing confusion as to the reach of the law in relation to a group who are at a heightened risk of experiencing this particular form of violence against women (see paragraph 10 above). Those involved in protecting children and young people most affected by this form of violence need to be able to offer clear advice and information and cannot be expected to differentiate their services according to the immigration status, or potential immigration status (as this might not immediately be clear, particularly in the case of a child at risk of imminent harm) of those they encounter.
19. Rights of Women and Asylum Aid therefore recommends that the Female Genital Mutilation Act 2003 be amended to protect all women and girls in the jurisdiction of England and Wales, regardless of immigration or other status.
FGM and asylum
20. In addition to the concerns raised above, Rights of Women and Asylum Aid are concerned that women at risk of FGM are failed by the asylum determination system.
21. Under the Refugee Convention asylum is to be given to those with a well-founded fear of persecution for one of the ‘Convention reasons’ (for example, race or political opinion) where the applicant is outside of her country of origin and that country is either unwilling or unable to protect them. FGM is considered a form of persecution in UK jurisprudence.5 The Asylum Instruction on Gender notes that:
“FGM, for example, is widely practised in some societies but it is a form of gender-based violence that inflicts severe harm, both mental and physical, and amounts to persecution.”6
22. The Home Office does not keep statistics on the forms of persecution asylum applicants’ claims are based on. During the past four years, over 20% of women seeking asylum were from FGM practising countries of origin and this percentage is growing.7 Not all these women cite FGM as a reason or a concern.
5 Secretary of State for the Home Department v K; Fornah v Secretary of State for the Home Department [2006] UKHL 46, 18 October 2006. 6 Asylum Instruction on Gender Issues in the Asylum Claim, September 2010, para. 2.2. 7 UN High Commissioner for Refugees (UNHCR), Too Much Pain: Female Genital Mutilation & Asylum in the European Union - A Statistical Overview, February 2013, available at: http://www.refworld.org/docid/512c72ec2.html [accessed 5 February 2014]. See also Female genital mutilation, asylum-seekers and refugees: the need for an integrated UK policy agenda Richard A Powell, Amanda Lawrence, Faith N Mwangi-Powell and Linda Morison, Forced Migration Review, 14, 2004.
137 23. The UNHCR has made the following observations about these claims:
“Asylum claims on FGM grounds are particularly complex and involve a growing variety of profiles at risk. In addition to the women and men activists persecuted for their opinions and commitment to end FGM in their countries of origin (political opinion) and/or their perceived threat to religious beliefs (religion), EU Member States have also been receiving claims from:
• girls and women who seek protection from FGM whether they come directly from FGM-practising countries or have lived most of their lives in the EU and face return at the time the claim is lodged; • girls and women who have already been subjected to FGM and seek protection from re-excision for instance or infibulation, defibulation or reinfibulation, upon marriage or at child birth; • girls and women who may suffer from a continuous form of harm and/or for whom there may be compelling reasons to seek protection arising from that past persecution; • parents claiming international protection to protect their (baby) daughters from FGM; • women who are under pressure from their families and communities but refuse to become excisers in light of the growing awareness generated by anti-FGM campaigns in countries of origin; • women who had been subjected to FGM, have accessed reconstructive surgery (often while in the EU) and who fear being cut again upon return for instance at the time of marriage.
These claims often give rise to additional considerations involving fear linked to early and forced marriage and domestic violence.” 8
24. Rights of Women and Asylum Aid submit that the complexities identified receive an inadequate response from the Home Office and that as a consequence women and girls at risk of FGM are not offered sufficient protection in the UK. In the landmark case regarding FGM in the UK, the woman concerned (who claimed that if she were returned to Sierra Leone she would be subjected to FGM) had to go all the way to the House of Lords to gain refugee status. In a gender analysis of UK asylum law, policy and practice carried out by Asylum Aid it is noted that:
“Generally, where a woman has already been subjected to FGM, the Home Office would not consider that she would face a risk of persecution on the basis of FGM in the future. However, this can be rebutted by
8 UN High Commissioner for Refugees (UNHCR), Too Much Pain: Female Genital Mutilation & Asylum in the European Union - A Statistical Overview, February 2013, page 32, available at: http://www.refworld.org/docid/512c72ec2.html [accessed 5 February 2014].
138 objective evidence/expert reports in particular circumstances such as for example where FGM was part of a ritual for the applicant to become a sowei, [a woman who performs FGM] or where FGM has been performed but there is also a risk of forced marriage or where the applicant is at risk of having the procedure re-done after the birth of a child. Alternatively, where applicants have had FGM undertaken, this can be an indication of a risk of FGM to their daughters.” 9
25. Home Office statistics show that women are more likely to have their asylum refusal overturned than men. In women’s cases studied by Asylum Aid, “the assessment of credibility formed the core of the decision to refuse” and in all the cases allowed at appeal (half of the sample), the immigration judge accepted the credibility of the applicants’ claim.10 This evidence regarding credibility and a culture of disbelief has been reiterated by Amnesty International UK and by the UNHCR.11 Home Office decision makers using the wrong standard of proof has a disproportionate effect on women as they are more likely than men to fear persecution in the private sphere, such as FGM, forced marriage and domestic violence, for which it is harder to provide documentary evidence and/or oral testimony.
26. In addition we are concerned that issues related to shame and stigma in relation to FGM are not sufficiently recognised and responded to by interviewers / decision- makers either in the Home Office, or, on appeal, at the Tribunal. Those making decisions about claims raising FGM often have incomplete or inadequate information about FGM in the country of origin and the reality of women’s experiences there. This is particularly of concern when it is submitted that the applicant could return to her country of origin and relocate internally to avoid being subjected to the practice on the basis of no or little supporting evidence and without any detailed engagement with the specific circumstances of the applicant.12 Similar decisions are also made on the basis of purported legal or other protections that in reality either do not exists or are inaccessible.
9 Querton, C (2012) “I feel like as a woman I’m not welcome”: a gender analysis of UK asylum law, policy and practice, Asylum Aid, London [page 28]. Available at:
12 Asylum Aid (2011) Unsustainable: the quality of initial decision-making in women’s asylum claims, London: Asylum Aid, [page 64] online. Available at: http://www.asylumaid.org.uk/data/files/unsustainableweb.pdf [accessed 6 February 2014]
139
27. Refugee and asylum-seeking women who are failed in the ways described risk being refused asylum and becoming destitute and therefore vulnerable to further exploitation, including sexual exploitation in the UK. There is an irony that the Government’s Strategy to End Violence Against Women and Girls has actions to protect women in the UK and abroad from FGM but misses out women who seek asylum in the UK from such abuses abroad. 13
28. Rights of Women and Asylum Aid, drawing on their own experiences and UNHCR research14, therefore recommend that:
a. Performance management for decision makers in the Home Office is enhanced to improve the quality of decision making, including making credibility assessments based on the correct burden of proof.
b. Decision makers in the Home Office are given better training to ensure that applicants raising gender-based claims, including FGM, are interviewed sensitively and appropriately in a manner designed to facilitate disclosure.
c. Gender-sensitive country of origin information is developed and is made available to decision-makers at all levels. Such information should specifically address the practice and prevalence of FGM in the country concerned, the position of women and the actual availability (rather than mere existence) of legal or other protections.
d. An end-to-end asylum determination system must be developed and implemented to ensure that destitution forms no part of an asylum- seeker’s experience. This is particularly important for applicants who are vulnerable, such as those at risk of FGM.
Catherine Briddick Debora Singer MBE Head of Law Policy and Research Manager Rights of Women Asylum Aid
11th February 2014
13 Singer, D (2013) Women seeking asylum – failed twice over in Rehman,Y. et al (eds) Moving in the Shadows: Violence in the lives of minority women and children, Ashgate, Farnham pp 225 – 243 14 Ibid.
140 Written evidence submitted by the Government
Introduction
1. Female genital mutilation (FGM) is a form of child abuse that the Government is committed to eradicating. We welcome the HASC Inquiry on FGM as a way to explore what more is required to tackle this horrendous crime.
2. The Government is clear that political or cultural sensitivities must not get in the way of preventing and uncovering this terrible form of child abuse. The law in this country applies to absolutely everyone.
3. FGM forms a key commitment in the Government’s ‘The Call to End Violence Against Women and Girls: Action Plan’. In tackling FGM, and all forms of violence against women and girls, we are adopting a robust, sustained and dynamic cross-Government approach in which every Government department is playing a part.
4. The Home Office leads the cross Government work on FGM and hosts bi- annual Inter Ministerial Meetings to monitor progress. Across Government, much work to tackle FGM has been developed in the last three years and we welcome the opportunity to update HASC on this progress. However the Government remains frustrated that a prosecution has yet to be brought for FGM and recognises the need to build awareness of this crime, further inspire cross agency working and to engage with communities to stop this practice.
5. Whilst the HASC Inquiry is focussing on FGM domestically it is important to recognise the links between work in the UK and our international work. FGM is unlikely to end in the UK before it ends in Africa and as a result there needs to be a dual international and domestic approach. In March 2013, the Department for International Development (DfID) announced a major new programme to support the Africa-led movement to end FGM. This programme, worth £35m over 5 years, is the largest donor investment in FGM ever. More information on this programme is attached in Annex A.
How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
6. The Ministry of Justice is responsible for the specific criminal law in this area in England and Wales - the Female Genital Mutilation Act 2003 (“the 2003 Act”) – and other more general provisions of the criminal law that may apply.
141 7. The 2003 Act extended significantly the protection that the law affords to victims of this unacceptable practice. It modernised the offence of FGM and the offence of assisting a girl to carry out FGM on herself while also creating extra-territorial offences to deter people from taking girls abroad for mutilation. To reflect the serious harm caused, the Act increased the maximum penalty for any of the female genital mutilation offences from 5 to 14 years.
8. Unfortunately, like the 1985 legislation that it replaced, the 2003 Act has yet to result in a prosecution. That is a source of considerable frustration. But it is not necessarily, as some have suggested, a reflection on the effectiveness of the law itself. The law in this area is adequate to deal with perpetrators if offences are reported to the police and the evidential and public interest tests for prosecution are met. At the time of mutilation, however, victims may be too young and vulnerable, or too afraid, to report offences. And they may be reluctant to implicate family members. These barriers to prosecution cannot easily be overcome.
9. Therefore it is important to find ways of building a case that do not necessarily rely on the testimony of child victims. The Government strongly support the action plan that the Director of Public Prosecutions (DPP) has published with a view to bringing a successful prosecution for female genital mutilation. We also very much welcome the assertion from both the former DPP Keir Starmer QC and his successor Alison Saunders CB, that they are confident that it is only a matter of time before we see a prosecution. And we welcome public statements from the police that both the resources and the will to bring perpetrators to justice, exist.
10. The CPS action plan commits to raising any issues about the current law with the Ministry of Justice. The DPP wrote to Ministers on 3 February with a paper identifying possible ways in which the criminal law could be strengthened to make prosecutions for FGM more likely. These include clarifying the law in relation to re-infibulation (the re-stitching of FGM type 3 following childbirth) and relaxing the definition of “permanent UK resident” in the context of extra-territorial offences. We will give careful consideration to the areas identified.
11. Of course the criminal law is only part of tackling the continuing problem of female genital mutilation in this country. Prosecution after the fact does not relieve the victim of the offence from a lifetime of pain and discomfort. Ideally, we want to prevent the mutilation from happening in the first place and anecdotal evidence has suggested that the 2003 Act has had some deterrent effect. In addition, there have been a number of police investigations which have contributed to interventions to protect girls at risk of FGM.
142 12. With that in mind, the Ministry of Justice is considering whether a civil law remedy may provide an additional tool to tackle FGM: the idea being that those afraid of being subjected to FGM – or friends and family members of those at risk – could apply for an order so as to put the potential victim under the protection of the court. Hence it would be a proactive rather than reactive step. Ministry of Justice will shortly be seeking views from key stakeholders on the merits of a civil law measure and how it might work alongside the criminal legislation.
Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
13. FGM’s prevalence in the UK is difficult to estimate because of the hidden nature of the crime. However a 2007 study based on 2001 census data suggested that:
• Over 20,000 girls under the age of 15 could be at high risk of FGM in England and Wales each year;
• Nearly 66,000 women in England and Wales were living with the consequences of FGM.
14. It is likely that, due to population growth and immigration from practising countries since 2001 that FGM is significantly more prevalent than these figures suggest. The Home Office has part funded a new study into the prevalence rates of FGM in England and Wales based on data from the 2011 census. The study is being undertaken by Equality Now and City University and the results are due to be published in the spring of 2014.
15. Anecdotal evidence is that the most likely barrier to identifying FGM is the pressure from the family or wider community. This can make it very difficult for girls and women to come forward to notify the police about what has happened to them. There may also be evidential and other difficulties if cases are reported many years after the event.
16. Safeguarding girls at risk of harm from FGM poses specific challenges because the families involved may give no other cause for concern, for example with regard to their parenting responsibilities or relationships with their children. However, there remains a duty for all professionals to act to safeguard girls at risk.
17. Under section 47 of the Children Act 1989, anyone who has information that a child is potentially or actually at risk of significant harm is required to inform social care or the police. The Government is clear that political sensitivities
143 must not get in the way of tackling FGM. Culture should not be allowed to take precedence over the law.
What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
18. The Government recognises that a joined-up approach across front-line agencies is needed to safeguard girls and protect women. That is why we launched multi-agency practice guidelines in 2011 for front-line professionals such as teachers, GPs, nurses and police. The guidelines aim to raise awareness of FGM, highlight the risks that people should be aware of and set out clearly the steps that should be taken to safeguard children and women from this abuse.
19. The guidelines are not statutory because we feel that the policies and procedures necessary to tackle FGM already exist. FGM can and should be tackled in the same way as other forms of child abuse or domestic violence which professionals already understand.
20. A review of the effectiveness of the guidelines was completed in 2013. It found that whilst the guidelines are highly regarded in terms of content, there was limited awareness of them. We are working across Government to identify opportunities to ensure the guidelines are made more accessible, including sign posting professionals to the guidelines via regular communication channels
21. The Government also recognises there is a need for a more co-ordinated local safeguarding response from health, social services and the police, and that there are issues with the current system which hamper information sharing, identification and intervention. Jane Ellison, Parliamentary Under- Secretary of State for Public Health, has asked the Department of Health to work with the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists and other colleges to ensure that professional training includes FGM and is of a high quality, including professional responsibilities in relation to safeguarding and reporting.
22. Similarly the Department for Education is also reforming social work education to provide a workforce better equipped to protect children from all forms of abuse. Sir Martin Narey’s review of social work education will be published shortly and the Department for Education will consider his recommendations.
23. The Department for Education expects to publish shortly revised Safeguarding in Education guidance. This statutory guidance, which replaces
144 2007 guidance, will be clearer and simpler and will direct schools to the latest expert advice on subjects like FGM
How can the systems for collecting and sharing information on FGM be improved?
24. The Department of Health announced in early February that all acute hospitals will report information about the prevalence of FGM within their patient population each month, with this return in place by September 2014. This will be the first time information about the incidence and prevalence of FGM in patients treated by the NHS has been collated at a national level.
25. In June 2013, the Home Office, the Metropolitan Police’s Project Azure and the NSPCC set up a specialist FGM helpline. It provides advice, information and assistance to professionals, the public and other key workers living and working within the communities that practice FGM.
26. The aim of this specialist helpline is to improve the protection and safeguarding of children in the UK by increasing the detection and protection of children at risk, or who have become victims of FGM. It seeks to improve information and intelligence sharing with the police and other key agencies to support action to be taken against those who facilitate FGM against children. Between 24 June 2013 and 31 December 2013, there had been 145 contacts made to the helpline (telephone or email), of which 63 were referred on to the relevant police force, 29 were advice, and 53 were enquiries.
27. The Government recognises that in order for the existing legislative framework to succeed, health professionals need to report both actual and suspected FGM. The Department of Health is developing a programme of work to improve the manner in which the NHS will respond to, follow-up and support the prevention of FGM. This will be achieved by routinely recording information relating to FGM and risk of FGM, and then collecting, sharing and finally using information to inform the provision of healthcare services and to support social services and the police in their work. The programme will work with other government Departments and agencies such as the London Mayor’s Office, Royal Colleges, voluntary organisations and others.
How effective are existing efforts to raise awareness of FGM?
28. The Government recognises that there is a need to raise awareness of FGM amongst professionals who have safeguarding responsibilities. Following a successful bid to the European Union, Progress funding stream, the Home
145 Office was awarded approximately 300,000 Euros in November 2013 for work to raise awareness of FGM in the UK. As part of this work, we are launching a communications campaign to raise awareness of FGM in March 2014. This will build on existing communication products, such as the FGM leaflet and poster already published by the Home Office. Key messages of the new campaign will include that FGM is child abuse and FGM is a serious criminal offence in the UK with a maximum penalty of 14 years in prison for anyone found guilty of the offence.
29. The Government also recognises that religious leaders can play a role in dispelling myths about FGM. No major religion condones FGM and in January 2014 Norman Baker, Minister for Crime Prevention and Lynne Featherstone. Parliamentary Under Secretary of State for International Development, met with faith groups to look for opportunities to work together to raise awareness of FGM. The Government is committed to pursuing this dialogue.
30. Using the European funding the Home Office has also committed to developing an e-learning tool so that all practitioners (social workers, teachers, health care professionals and police) will be able to undertake an introduction to FGM. We will raise awareness of the new e-learning tool through carrying out a national outreach programme with Local Safeguarding Children’s Boards.
31. In October 2012 the Home Office published the ‘Statement Opposing Female Genital Mutilation’ leaflet. This pocket-sized document sets out the law and the potential criminal penalties that can be used against those who commit, or assist someone else to commit FGM. It can be discreetly carried in a purse, wallet or slipped into the back of a passport. This tool is directed at families who have immigrated into the UK and do not want their children to be subjected to FGM, but still feel compelled by cultural and social norms when visiting family abroad. It is supported and signed by Ministers from the Home Office, Department of Health, Ministry of Justice, Department for Education and the Director of Public Prosecutions (DPP). To date we have distributed over 41,000 statements across the UK.
32. The Department of Health has developed a webpage on FGM on www.nhs.uk/fgm and the DH FGM DVD (2007).
33. Over the last two years there has been a significant increase in media and parliamentary activity around FGM. Campaigns in newspapers such as the Evening Standard and The Guardian have increased awareness of the issue. This is in large part due to the lobbying of voluntary sector groups, such as Equality Now, Daughters of Eve and Forward and also due to the work of the All Party Parliamentary Group on FGM.
146 How can the available support and services be improved for women and girls in the UK who have suffered FGM?
34. FGM forms a key commitment in the Government’s ‘The Call to End Violence Against Women and Girls: Action Plan’. Through the plan we encourage all parts of the system to work together to identify, protect and support victims and bring perpetrators to justice.
35. The Home Office is developing an FGM Resource Pack for local areas. The pack will emphasise what works in tackling FGM and will highlight case studies from areas where effective practice has been identified. We aim to publish the resource pack and prevalence study in the spring of 2014, thereby equipping commissioners with both the data they need to understand the scale of the problem in their area and an insight into some of the tools they can use to effectively tackle it.
36. For those victims of FGM who feel able to report offences to the police and to give evidence in court, we must ensure that they receive the right support at the right time from criminal justice agencies.
37. The new Victims Code which came into force on 10 December 2013 sets out the information, support and services that victims can expect to receive from criminal justice agencies in England and Wales at every stage of the process. The Code forms a key part of the Government’s strategy to reorient the criminal justice system in favour of the victim to help make the system more responsive and attuned to their needs. It also includes an enhanced service for victims of the most serious crime, persistently targeted and vulnerable or intimidated victims. Victims of FGM are entitled to an enhanced service as victims of the most serious crime.
38. Vulnerable or intimidated victims and witnesses can benefit from support in the form of special measures whilst giving evidence in court. These measures support them in giving their best evidence, as well as help to reduce some of the anxiety of attending court. Special measures to support intimidated witnesses particularly include giving evidence by live video-link, the use of recorded evidence-in-chief and screens to visually shield the witness from the defendant in court.
39. The NHS offers FGM specialist services: there are currently 14 specialist clinics in England which are run by experienced professionals and gynaecological and routine antenatal care for FGM victims. Most also offer de-infibulation ("reversal") services. These clinics are run by female staff who have an understanding of FGM and what women have undergone. Translation services are available.
147 40. The Department of Health’s programme of work around information sharing is intended to increase awareness of the services available, so that wherever a victim presents she will be referred to the most appropriate service.
41. The Government knows that we need to do more to support and protect victims of FGM and the new Violence Against Women and Girls Action Plan due to be published shortly will contain further commitments on how we can tackle FGM and support victims.
42. We are always looking for innovative ways to tackle this abuse and will carefully consider the recommendations made by the HASC Inquiry. FGM is not a problem that can be solved by Government alone. Indeed, the progress that we have made so far would not have been possible without the commitment of the voluntary sector partners and frontline professionals who tirelessly campaign on this issue.
148 Annex A - DFID WORK ON FGM
During 2013, UK leadership on FGM has played a major role in raising the profile on the international agenda of this neglected issue. In March 2013 DFID announced a major new programme to support the Africa-led movement to end FGM. This programme, worth £35m over 5 years, is the largest donor investment in FGM ever.
DFID Africa Regional programme: ‘Towards ending FGM/C in Africa and beyond’ (approved March 2013 and now in implementation phase). Up to £35 million for the first 5 years; expected to be a 10 year programme subject to review after 5 years. The programme aims to bring about a reduction of cutting (incidence) by 30% in 10 countries over 5 years
This programme includes three components:
1. Targeted community-level programming to support social change, including awareness-raising and education; and support to policies and legislation and their appropriate implementation, in 17 countries (implemented by the UN Joint Programme – UNICEF and UNFPA); 2. Global social change campaign – to galvanise a movement to end the practice, with efforts at community level, to support national campaigns, and to galvanise international political and financial commitment. This also includes up to £1m to support UK based diaspora groups for efforts to end the practice in their countries of origin (implemented by a contracted consortium led by Options and including Equality Now and Forward; programme started January 2014). 3. Research - to build a robust evidence base to improve global policy and programming on FGM. Including greater understanding of the extent and drivers of the practice, what works to end the practice and the impact of both FGM and efforts to end it on the wider situation of girls and women. (To be tendered early 2014.) There will also be an independent evaluation.
In addition DFID is supporting a country programme in Sudan to address FGM (£12m over 5 years with a planned 2nd five year phase; started in 2013). In partnership with UNICEF, UNFPA and WHO this programme focuses on supporting the abandonment of the practice and evaluation to build the evidence base on what works.
149 Written evidence submitted by Bawso
1. About Bawso Bawso is an All Wales organisation delivering specialist services to Black and Minority Ethnic (BME) Communities who are marginalised which was established in 1995. It is an Accredited Support Provider for the Welsh Government with an excellent track record of managing complex and diverse services across Wales through provision of our purpose built refuges, houses, and an extensive Outreach, Resettlement and Floating Support, Human Trafficking, Forced Marriage and FGM Health & Safeguarding Projects. Bawso holds Investors in People award and received the Quality Mark at General Advice Level by the Legal Services Commission.
Bawso currently supports more than 3000 women, children and young people annually.
2. FGM Project The Bawso FGM Health and Safeguarding community based project was set in 2010 and is funded by the UK FGM Joint Initiative. The project aims to strengthen community ownership of FGM and taking action towards its eradication through: ◦ Prevention ◦ Protection ◦ Support
Since inception the project has engaged with more than 600 people to date through raising awareness events (seminars, workshops & training) and one to one support.
3. Question One: How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
3.1 The existing legislative framework on FGM is not very effective of a general lack of awareness of its prohibition in the UK. For example, there remains a lack of knowledge of the legislation among newly arrived individuals and therefore they are not aware of that it is illegal in the UK. In other instances people still believe in the myth that FGM is a religious obligation so go to every extent to ensure that their children undergo the procedure.
3.2 Whilst there is a clear legislative frame, key practitioners who are best placed to identify who is at risk of FGM are not trained adequately. As a consequence, opportunities are missed.
150 There is no clear and integrated work guideline amongst key practitioners including health, police, social services and third sector in regards to people who have just arrived in the country; awareness raising within communities who have been living in the UK but still do not fully comprehend the health, social and psychological impact of FGM and there is still a big gap around data recording of people who have undergone FGM.
3.3 Recommendation for the legislative framework: Development of an integrated framework that lays out a systematic workflow in tackling the issue between the key practitioners and ensures that all are adequately trained to respond to the issue. It is important to clearly identify who; what to do; when to do it; where to apply at every stage of work in tackling the issue including intervention, prevention, treatment, prosecution).
4. Question Two: Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
4.1 The groups that are most at risk of FGM are children and young people from countries where there are high practice rates such as Gambia, Sierra Leone, Somalia, Djibouti, Ethiopia, Sudan, Kenya and Egypt for example. However it should be noted that children from communities with low practice rates are also at risk because practitioners are not on the lookout for them. For example, people from Indonesia and Malaysia are rarely considered to be at risk and could be missed by practitioners.
4.2 There are different reasons why it is difficult to identify some types of FGM. For example the type I (Clitoridectomy or small cut to the clitoris) is sometimes difficult to identify.
4.3 FGM is largely practised by people within closed communities and involves close members of the family. Therefore it is not discussed outside the home at all. Our experience has shown that sometimes people feel disempowered to challenge the practice because of certain cultural norms. For example, young people we have worked with expressed frustration that their parents did not listen to them: ‘I would not bother because they would not listen’ (young female 14yrs), ‘I would be too scared to say anything’ (young female 16yrs).
4.4 One of the key barriers to intervention is the lack of understanding of FGM by practitioners. A recent survey of professionals from Education, Health, Social Care and Criminal Justice as well as others from housing and the legal profession in Wales
151 revealed that although 90% (of 400 respondents) were aware of FGM, more than half (52%) were unsure exactly who was at risk. The confidence of professionals in being able to protect those at risk was low. In addition, 43% and 69% respondents respectively were ‘not confident’ or ‘very unconfident’ to protect children from FGM. Only nine of the respondents felt they would take actions on FGM, whilst some did not feel it was in their place to deal with this, and others said they would find it uncomfortable or embarrassing to discuss a child’s genitals with anyone1.
5.5 Knowledge of statutory guidance Worryingly 43.8% of respondents had no knowledge of any statutory guidance on FGM. 44.9% of respondents were aware of the All Wales Child Protection Procedures protocol on FGM and 31.7% knew of the UK Government guidelines on FGM. Two respondents also identified Local Safeguarding Children’s Boards (LSCBs) and the Female Genital Mutilation Act 20032.
5.6 Training on FGM Respondents were asked about the training they had received on FGM in both their current role and ever (in any previous role). In both instances the majority (58.8% current role; 51.4% in any role) had not received training on FGM. However, there was a strong desire for training with 71.2% indicating that this was an issue that they would like more information or training on3.
6. Question Three: What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co- operation be improved?
6.1 Each agency has a role to play in the fight against FGM and it is only through multi- agency co-operation that any headway can be made. For example, the public have a role to play by informing the police if they suspect that anyone is at risk of undergoing FGM. In such as instance the police will have the responsibility to investigate the intelligence and take action in a sensitive way.
6.2 Health is sometimes best placed to identify people who have been cut when they present during pregnancy or with medical complications as a result of FGM. In such an
1 Wales FGM Forum Survey of Professionals (December 2013 – January 2014)
2 Ibid
3 ibid
152 instance health practitioners have the responsibility to record all the information of people who have undergone FGM. In particular if such a woman gives birth to a girl child. This information should be recorded in such a way that other practitioners involved with the family and child at various stages are aware (i.e. health visitor, school nurse and GP) to intervene if need arises. This would require very clear information sharing which is backed by protocols.
6.3 Third sector agencies can provide support to survivors as work collaboratively with the public sector as they are sometimes best placed to provide an alternative view which the individual is more comfortable with.
7. Question Four: How can the systems for collecting and sharing information on FGM be improved?
7.1 As indicated in the previous response, there is need for clear information sharing protocols which are signed by all partners. The information should be shared equitably among all the partners. That is, both statutory and third sector organisations should share information equally and remove the burden of sharing from just the third sector.
7.2 There is also a need for clear method and guidance for the key practitioners on how to gain information from the community and for proceeding referrals. Apart from reviewing the existing multi agency guidelines, it is important to deliver training alongside to ensure that people actually understand them.
8. Question Five: How effective are existing efforts to raise awareness of FGM?
8.1 The on-going efforts to raise awareness of FGM are to some extent effective. However, the biggest challenge is that these efforts are sporadic and inadequately funded. For instance in Wales there is only one organisation (Bawso) running a project to raise awareness in Cardiff and Newport which is funded by the FGM UK joint initiative. FGM UK initiative funding is quite limited, therefore as part of the project, raising awareness is carried out in the communities; in schools and sometimes among practitioners. However, population of BME people in Wales increased by more than 100% (from 61,580 in 2001 to 133,820 in 2011)4. The FGM initiative is not able to fund raising awareness for key practitioners in the public service. There is need for government to fund training for practitioners in statutory agencies such as Health, education and Social services for example because of their safeguarding responsibilities.
4 Office of National Statistics
153
8.2 There is a need to have national mandatory and consistent training for all practitioners who are likely to come into contact with individuals affected by FGM (for example, health, education, social care/service and third sector).
9. Question Six: How can the available support and services be improved for women and girls in the UK who have suffered FGM?
9.1 Support and services for women and girls in the UK who have suffered from FGM can be improved by joint up multi agency work which is guided by very clear strategy. The importance of practitioner raising awareness cannot be underestimated in this process. There is need for clear pathways of how to support women and children at the point of need. For example, in Wales there is no dedicated clinic where women who have undergone FGM and require support can go. The women have to go through the ‘normal’ referral process and waiting list. The wait can sometimes discourage the women and girls from accessing support.
154 Written evidence submitted by Muslim Women’s Network UK
INQUIRY INTO FEMALE GENITAL MUTILATION (FGM)
Introduction
1. Muslim Women’s Network was formally established in 2003 with the support of the Women’s National Commission (WNC), to give independent advice to government on issues relating to Muslim women and public policy. In 2007, Muslim Women’s Network decided to establish itself as an independent organisation to ensure its autonomy from Government. We renamed the group ‘Muslim Women’s Network UK’ (MWNUK) and became a Community Interest Company in 2008. In December 2013 we formally became a registered charity1.
2. Our aim is to gather and share information relevant to the lives of Muslim women and girls in order to influence policy and public attitudes, to raise the profile of issues of concern to Muslim women and to strengthen Muslim women's ability to bring about effective changes in their lives.
3. At the time of writing, MWNUK has a membership of 500 that includes individuals and organisations with a collective reach of tens of thousands of women. Our membership is diverse in terms of ethnicity, age, religious backgrounds, lifestyles, sexual orientation and geographic location. Members are also from a range of employment sectors including: higher and further education; voluntary sector and support services including services workers; health and legal professionals; the police and criminal justice sectors; and local and central government. Our members are mainly Muslim women living and working in the UK while our non-Muslim members work with or on behalf of Muslim women.
4. Supporting actions to addressing female genital mutilation is part of our overall commitment to combatting violence against women and girls, which is one of our seven current priority areas. As the only national Muslim women’s organisation in the UK we have been very aware of the issue of FGM within Black Minority Ethnic (BME) communities with an overlap into the Muslim community. In turn we have carried out a range of activities to tackle the issue including creating fact sheets and podcasts raising awareness and educating others as well as talking in the media and at a grassroots level; in February 2013 we included FGM as an abuse within our postcard campaign directed at mosques and also spoke to the residents of East London on the matter.
Evidence
5. MWNUK’s constant concern has been that whilst FGM is a complex issue prevalent within a wide cross-section of communities of varying faiths and ethnicities, there are
1 Charity Registration Number: 1155092
155 particular hurdles and barriers as well as systematic failures which as a collective are contributing towards the continued existence of FGM in UK.
6. We believe that victims/survivors, including potential victims are at particular risk of being overlooked by service providers and support agencies due to a lack of will, understanding and/or ability. In turn, it leads to an inability to deter perpetrators. We attempt to address these matters within the following questions of the Inquiry and hope our comments are taken into consideration during your investigation into female genital mutilation.
7. At this stage, we would like to clarify that MWNUK strongly disagree with any suggestions that FGM is an Islamic practice; on the contrary we consider FGM to predate Islam with no authentic basis to validate any such connection. We consider it to be a form of violence inflicted upon women and girls which must be eradicated throughout the whole world, not just the UK. For further information please see our website.2
How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
8. Despite FGM being a criminal offence in the UK, not everyone is aware of this legislation and more worryingly, there are individuals who are aware but are still not deterred. Thus, whilst a framework exists, the lack of prosecutions despite the continuing abuse highlights its serious ineffectiveness.
9. Evidential issues are consistently put forward as key hurdles in achieving prosecution despite the very physical and visual proof that FGM has occurred on the victim. We are aware of the complexities involved including the fact that perpetrators may be family members themselves, the age of the victim, and issues of stigma within the community. However, we suggest that there is a misguided overemphasis on needing victims/survivors to shoulder a case – if this approach was taken towards all violence against women and girls offences, would this not naturally affect prosecutions?
10. There is a serious need to consider alternative means by which to pursue prosecutions. This would not only include better policing strategies such as surveillance of serial perpetrators who carry out FGM on behalf of family members but also an evaluation of any circumstantial evidence available which may help strengthen a case. We would also suggest legislative changes by which parents and potential others may be charged due to a failure to protect under-age victims from harm; the fact that FGM has occurred would therefore directly implicate those with parental responsibility thus alleviating the need for a child’s evidence or even the need to identify who performed the FGM etc. We suggest that a similar method of responsibility is placed on professionals such as those working in health and education for not reporting an offence or potential risk.
2 http://www.mwnuk.co.uk//go_files/factsheets/518708-FEMALE%20GENITAL%20MUTILATION%20factsheet.pdf
156 11. We would also like to highlight an obvious deterrent in victims/survivors and also any witnesses coming forward – a lack of protection and support available. As well as a need for better training and understanding of the complexities involved, we ask that consideration be given to legal mechanisms available such as witness anonymity or pre-recorded evidence. Such measures may not only assist in preventing external factors such as social stigma or threats but will also take account of the very personal difficulties involved in recounting such experiences.
12. Finally, we ask that you consider introducing similar strategies to that followed in cases of domestic violence or sexual offences, such as domestic violence protection notices and orders, forced marriage protection order or sexual offences prevention orders. As stated, we are aware of the particular issues of victims/survivors not wanting to report their family members however at the same time it is necessary for such family members to understand that an offence has been committed which has, and will, have a detrimental impact on their child. In such situations an alternative approach may be to serve a notice akin to that for domestic violence for example thus allowing evidence for any further FGM committed on a member of the family; by following a similar process it will allow police and other agencies to be alert as to risk to any other potential victims and also hold evidence for future prosecutions whilst at the same time providing victims/survivors with the opportunity to come forward without feeling guilt for criminalising their family – that is, they can be reassured that it was not their actions in coming forward but rather the persistence of the perpetrators despite warning and support in addressing the practice that has led to any prosecutions. We hope you appreciate of course that this is not a clear-cut procedure being put forward but rather a potential idea to be further developed. For such measures to work it would also be necessary to have a dedicated support network together with a means by which to assist in educating perpetrators and accomplices in a bid to re-educate the communities involved.
13. On a further note, we ask that you address the clear discriminatory aspect of legislation by which it is only an offence if victims are British nationals or “settled”; all children and young people should be protected irrespective of their arrival date into the UK.
Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
14. Whilst we appreciate that FGM is more common in certain groups in the UK perhaps more than others, we respectfully suggest however that this line of enquiry is unhelpful in tackling the issues. By attempting to identify the groups at most risk it is possible that other potential victims are missed or ignored. We would suggest that an alternative approach would be to start treating FGM just the same as any other form of violence against women whereby the focus is on the offence and the individual vulnerabilities of the victim are included as part of an overall assessment; when identifying those at risk of sexual abuse in UK for example, it would not be appropriate to start by considering which groups are more at risk but rather it is, or should be, understood that sexual abuse is a sad and unfortunate reality in all communities. During our research into sexual exploitation of Asian girls and young
157 women we had uncovered that Asian victims were being missed as a result of a misbelief that Asian girls and young women are not subjected to such abuse (Unheard Voices, 2013). Taking such an approach towards FGM may lead to similar consequences whereby a belief that the practice is more prevalent in one group creates an assumption that it is not in another. This is irrespective of the fact that we do understand that there are indeed groups more at risk and our suggestion of utilising an approach more in line with other forms of violence against women will encompass such risk assessment without potentially leading to missed victims.
15. The above approach will also allow us to take account of any changes within communities and ensure vigilance against FGM at all times. It must be remembered that the reasons for performing FGM vary from person to person - some may do so in order to protect cultural ideals and/or identity, some may wrongly believe this to be a part of their faith, some may consciously adhere to the patriarchal notions that underpin the existence of the practice – and in turn, people may be drawn towards FGM for such reasons even if the practice was previously unknown to them.
16. One individual for example, who was not a victim nor knew a victim, was told that FGM is an Islamic practice which whilst not compulsory was a preferred practice and it was only through further research that she was able to uncover that this was incorrect – her concerns upon finding out that she was fed false information was that others on a spiritual journey like her who are trying to better themselves in their faith may fall into such traps and may begin pursuing a practice due to a lack of knowledge and understanding of the exact effects.
17. Interestingly, a particular point raised by the above individual was her lack of understanding of what in fact entailed FGM and in our opinion this is a part of the barriers towards identification and intervention. There may be individuals within a community, such as young men, who are aware of the practice but unclear on the specificities and the harm caused. Similarly, there may be front-line professionals in a position to provide information on a potential victim but a lack of knowledge of the exact practice and impact makes them minimise the issue. Better education and training in this regard would therefore assist in overcoming such barriers and assist in disclosures.
18. Moreover, we are consistently told, and have been for many years, that there is reluctance by key professionals including health care professionals and police, to interfere in what they regard as culturally or faith sensitive matters. It is vital that this is addressed immediately through proper education and training; we would suggest that this include information highlighting the alternative voices of the communities, that is, highlight that there are key individuals and organisations including faith leaders within the communities themselves striving to end FGM and therefore it is not about cultural factors but rather about violence against women.
What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved? How can the systems for collecting and sharing information on FGM be improved?
158
19. As highlighted above, front line professionals such as those within education and social care are key in tackling FGM in the UK. Indeed, we believe it is the lack of multi-agency approach thus far that has allowed FGM to continue in UK. Health, education and social care professionals have a particularly important role to play given they are likely to be the first point of call in terms of disclosure. We would suggest that a policy is put in place making it mandatory for any evidence or potential risk to be reported in the first instance for further investigating; we further suggest that a dedicated team of trained officers is set up to pursue the lines of enquiry further.
20. Further training, education and support will be necessary to ensure success in such an approach. It is also necessary to have proper information sharing procedures in place which ensures immediate actions and continuous reviews where necessary; for example, where a teacher has raised concerns of a child being taken abroad it is vital that this is kept under review by both police and social care professionals so that the child at risk is not missed later on down the line.
21. We must also highlight that teachers themselves have a very important task to play in this regard – that is, they are best placed to educate students on issues such as FGM and other forms of violence. In fact, we would like to see such topics becoming a part of the curriculum in a bid to increase awareness and assist in prevention. By doing so, this would allow awareness-raising without specifically targeting any particular students.
How effective are existing efforts to raise awareness of FGM?
22. Whilst there has been an improvement over the years, in our opinion credit for such can only be given to NGO’s and individuals working at a grassroots level to tackle the issues rather than on a wider scale. Indeed, much needs to be done in raising awareness across all sectors.
23. Our work has highlighted the lack of awareness in schools even from students who are regarded as being part of a community in which FGM is practised; better awareness may mean students are able to call for help for friends and peers.
24. We are also concerned as to how FGM tends to be discussed generally with a link to immigration and/or religion, which we believe conflates an issue and takes it to a direction that is both unhelpful and unfair for victims/survivors. Training sessions and presentations during university lectures for example, can include language and terminology by which the practice is regarded as one only of relevance to the deviant “other” which rather than promoting collective actions can seem divisive. It is essential therefore that a properly effective training programme is developed which can be utilised across the board; if the intention to stop FGM is sincere we would ask that proper attention is directed to training and development as without a thorough multi-agency approach, FGM will continue.
159 How can the available support and services be improved for women and girls in the UK who have suffered FGM?
25. The key theme within our Evidence has been the need to keep the victim/survivor at the forefront of all considerations who may face a range of issues including physical, psychological and societal, such as the fear of abuse or stigma. There may also be additional issues of consideration which may or may not be linked to the issue of FGM.
26. We ask therefore that due consideration is given to the needs of victims/survivors whether this is at initial disclosure and evidence gathering, in terms of health related matters or issues stemming from societal problems such as the need for alternative accommodation or relocation.
Final Comments
27. We have already commented on the need for collective action and a multi-agency approach; we ask that you bear in mind that this is sought in order to assist those who have fallen victim and protect those at risk from becoming victims. This is only possible if an unqualified commitment is made to ending FGM in UK which takes into account all the issues of relevance.
28. As a point of clarification, we must explain that our comments and examples have been limited to BME and/or Muslim victims due to the nature of our organisation and its work. As a national Muslim women’s organisation our work predominantly deals with Muslim and BME women albeit we also work with individuals of other faiths and are therefore also aware of issues of relevance to other faith communities. In turn we wish to clarify that where we ask for faith and culturally sensitive support packages and mechanisms we do so on behalf of victims of all race, ethnicity, religion and faith.
29. We also wish to reiterate that we do not consider FGM to have any basis within Islam and therefore from our perspective it is not a practice justified through the Islamic faith; we consider it to be violence against women and girls and ask that it be treated accordingly.
30. As a national women’s organisation committed to combatting FGM, Muslim Women’s Network UK would like to express its willingness to assist through training, support, information or advice or any other means in order to ensure that any cases are prosecuted accordingly and preventative measures put in place for the future.
31. We would like to thank you for providing us with the opportunity to respond to your Inquiry and hope that our evidence proves to be helpful in your considerations.
On behalf of Muslim Women’s Network UK, Nazmin Akthar Vice-Chair
160 Written evidence submitted by Fahma Mohamed
COVER NOTE:
1) I am writing to respond to the inquiry into Female Genital Mutilation. My response will address the questions: How effective are existing efforts to raise awareness of FGM? And how can the available support and services be improved for women and girls in the UK who have suffered FGM?
2) I am 17-year-old student from Bristol. I come from a British-Somali family. I started campaigning around FGM after I got involved with Integrate Bristol, a charity working with young people from different countries and cultures.
3) 193,000 people have signed my petition on Change.org calling on Education Secretary Michael Gove to tell schools to teach risks of female genital mutilation. The petition can be found at www.change.org/endFGM. I would like to ask the committee to consider the petition and the comments left from members of the public during this inquiry.
4) You wouldn't think that British teenagers have to worry about FGM but we do. I know of people who have been cut - anyone who knows girls from FGM affected communities will know girls who have been cut. My classmates and me campaigned for our school to do more on FGM. Now all the girls at school know the risks of FGM and feel able to talk about it. But this is one school. We need this to happen at every school in the country - so that no girl is missed.
5) If every headteacher was given the information they need to talk about FGM to students and parents we could reach every girl who is at risk. Many girls are cut over the summer holidays. It is called the 'cutting season'. It is very important that schools have information to deal with FGM around this time.
6) Working with schools to raise awareness and education among young people and their parents will help end the silence around FGM in this country and break the cycle so the next generation is safe.
7) The incredible response I have received from my petition shows how strongly the public want to see action from the Department of Education working with schools to address FGM. I also enclose a small selection of the comments submitted by teachers in response to the petition.
8) I urge you to consider the action schools should take to help raise awareness of FGM.
Yours sincerely, Fahma Mohamed
PETITION: 9) Secretary of State for Education, Michael Gove: Tell schools to teach risks of female genital mutilation before the summer Signed by 193,000 Full text and signatures count can be found at www.change.org/endFGM
161 COMMENTS FROM TEACHERS WHO SIGNED THE PETITION:
10) Liam, Bristol: I'm a teacher in an inner city school and have seen the shady, clandestine nature of FGM. It robs children of their innocence. If it were white British children, there would be a national outcry.
11) Denise, Nottingham: I'm a teacher, a woman, and I'm appalled that so little is being done about this issue - no amount of cultural or political sensitivity about this can be allowed to get in the way of making a dramatic change for the better.
12) Alice, Wimbledon: I'm a teacher and want all teachers to make their students aware of FGM so that maybe some horrendous crimes can be prevented.
13) Claire, Bristol: I'm a teacher and more of my students fall into social groups that are affected by this atrocity.
14) Jack, London: I'm a teacher. My school has a large Somali majority. We know that FGM is a big issue, but we never mention it.
15) Claire, Rishton: I'm a teacher, and the thought of this happening to some of my girls leaves me horrified.
16) David, London: I believe FGM it is a fundamental breach of human rights. As a teacher I have raised this issue with teenagers and the level of ignorance among some as to their personal rights, the effects it has and what it entails is very worrying and enables this crime to go unreported.
17) Maureen, Woodford: As a female I believe this is an appalling practice. I am horrified that, although the practice has been illegal for nearly 30 years, there has not been one prosecution. Why? As a teacher I can only talk about this in terms of male decision-making. There is no other reason. This should be addressed as a matter of urgency.
18) Hannah, Portsmouth: As a teacher I think it's important to teach girls and boys about this to prevent it from happening to them or to others.
19) Melanie, Bolton: As a teacher I am trained to look out for and report suspected abuse of children. By not communicating directly with schools, Gove is condoning the horrific practice of FGM. He should hang his head in shame.
20) John, Hull: As a teacher of English for Speakers of Other Languages (ESOL), I am aware of how vulnerable some girls are to this kind of abuse and how isolated their mothers can be from support, especially when they have only been in the UK for a short time and are isolated by culture and language from wider opinion and the wider community.
21) Annie, Brighton: As a teacher I would welcome clear guidance on protecting vulnerable young girls and how to uphold our own laws regarding this distressing act suffered by so many UK citizens. We must protect them.
22) Kate, Hull: As a teacher, I know that many of my colleagues in the profession are in full agreement that FGM needs to be addressed in schools. We need to be given the freedom to do so. Good luck with your campaign.
162 23) Jennifer, London: As a teacher, we need resources and training to be able to even begin to discuss this important issue. Having now supported young women at risk, the amount of ignorance around the subject is scary - please help schools prepare to address this.
24) Christopher, London: I worked with many Muslim people as a teacher and school inspector and this subject was taboo. Obviously, those who practise it are ashamed and rightly so. It is child abuse.
25) Christine, Dudley: Because as a teacher I know what this abuse can do to damage the life chances of those who are brutalised by this horrific procedure.
26) Doreen, Carshalton: As a teacher we need to care about the whole child. And an abused and damaged child will have difficulty engaging in the learning process. And child mutilation is child abuse!
27) Naomi, Hove: As a teacher, I am very aware of the trauma this causes girls I have taught. It is something they can't talk about because there is no 'box' for it in PSHE or in pastoral programmes with form tutors. When birthdays approach, and those long summer holidays, there has always been the tension of fear - that girls in my care may be faced with FGM - or indeed, arranged marriages. The point about Chinese foot binding is powerful - change CAN come about. This is 'better late than never' for FGM. Please, make this change happen this year!
28) Colin, London: As a teacher I believe in education and informed choice; for parents as well as their children.
29) David, Stoke on Trent: As a parent and as a teacher I believe that this practice is inhuman and abhorrent. Disguised as a pseudo religious practice it is a physical and mental form of abuse with no basis in religion, no health benefits and resulting in girls and young women living in pain and fear. Why isn't more done to educate communities, the NHS, teachers to identify and report these criminals (yes its illegal) and stamp out this barbaric practice once and for all.
30) Anna, London: As a teacher myself I am aware just how much work needs to be done in schools on preventing FGM.
31) Marie Anne, London: As a teacher myself (infant school) I wholeheartedly agree that it's high time this was stopped and the perpetrators prosecuted. We need to make it part of the curriculum as soon as possible.
32) Anna, Hemel Hempstead: As a teacher I would be happy to teach his and also, support colleagues who feel less confident. This is such an important issues and needs to be taught to all students...boys and girls!
33) Paul, London: As a teacher for many years in Central London I saw the distressing effects of the 'summer trip home' in too many students. Teachers and other professionals need support, training and leadership to strengthen response.
34) Anna, Southsea: As a teacher I know how important it is to be armed with the knowledge to help protect pupils who are at risk.
35) Pamela, Leyland: I was a teacher for 34 years and know how powerful education can be; having FGM discussed in schools is a first step to it being
163 wiped out.
36) Kate, London: As a teacher I have taught students about this topic and every time I do so at least 1 girl tells me she has a relative this has happened to but didn't know it had a name or that it happened to anyone outside their family.
37) Nathalie, London: As a teacher I would be horrified if FGM was carried out on my pupils without repercussion to those who have consented or carried out this harrowing procedure.
38) Andrew, Northampton: As a teacher I feel awareness and an impartial discussion of the issue can only be educational.
MORE COMMENTS CAN BE VIEWED AT: www.change.org/endFGM
______Fahma Mohamed, 17 year-old-student at City Academy, Bristol
164 Written evidence submitted by FPA and Brook
February 2014
About FPA
FPA is one of the UK’s leading sexual health charities. Our mission is to help establish a society in which everyone has positive, informed and non-judgmental attitudes to sex and relationships; where everyone can make informed choices about sex and reproduction so that they can enjoy sexual health free from prejudice or harm.
We do this through providing a comprehensive sexual health information service for professionals and the public, running community based sex and relationships education programmes and campaigning to ensure that high quality sexual health information and services are available to all who need them.
To find out more about FPA and the work we do please visit our website: www.fpa.org.uk
About Brook
Brook is the UK’s leading provider of sexual health services and advice for young people under 25. Our mission is to ensure young people can enjoy their sexuality without harm. Brook services provide free and confidential sexual health information, contraception, pregnancy testing, advice and counselling, testing and treatment for sexually transmitted infections and outreach and education work, reaching over 290,000 young people every year.
Brook believes that every young person in Britain deserves sex and relationships education (SRE) that is relevant to them, focuses on relationships as well as sex, honest about human sexuality and taught by professionals who are well prepared and confident. Sex and relationships are a life skill, as important to our future health and happiness as any other subject, and young people deserve to be heard.
To find out more about Brook visit: www.brook.org.uk.
Response to questions
1. How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
1.1 With the NHS estimating that 20,000 girls under the age of 15 being at risk of FGM, and 60,000 women living with the consequences of FGM1, FPA and Brook
1 http://www.nhs.uk/Conditions/female-genital-mutilation/Pages/Introduction.aspx
165 believe that the existing legal framework needs to go much further in order to promote and complement outreach into communities and ensure adequate levels of professional interaction in such communities.
1.2 The difficulty with investigating and prosecuting crimes under this legislation lies in the fact that FGM differs from other forms of child abuse in two important respects:
a) Despite the severe health consequences, parents and others who have this done to their children genuinely believe that this is in the child’s best interest to conform with their prevailing ‘custom’. They believe it makes the child socially acceptable within their community and do not intend it as an act of abuse; and
b) There is no element of repetition; it is a one-off act of abuse (although younger female siblings of any child found to have been mutilated may be at risk).
1.3 Further barriers include that:
• In some instances, while countries have anti-FGM legislation in place, in practice it is not supported and the practice continues, therefore impacting on the ability of UK-based prosecutions, particularly where someone has been sent abroad for the operation, then returns to their family in the UK.
• FGM is deeply steeped in the culture of the practising communities who may resent what they perceive as the imposition of western values on them.
• Officers sometimes feeling reluctant to investigate alleged offences of FGM for fear of being considered racist.
2. Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
2.1 FPA and Brook believe that groups of people originating from African, Middle Eastern and Asian countries are most at risk of FGM, particularly with regards to families who have girls aged between four or ten.
2.2 In the UK, FGM is most often seen in minority ethnic populations from Somalia, Sudan, Eritrea, Dijbouti, Ethiopia, Sierra Leone and Nigeria. Within the UK, families are likely to seek a traditional circumciser from their own community to perform the procedure on their daughters, though often we have found that girls are sent abroad ‘on holiday’ to have the operation undertaken too.
2.3 FGM is most commonly carried out on girls between the ages of four and ten, but it is sometimes performed at times shortly after birth, in adolescence, at the time of marriage or of the first pregnancy, usually performed by traditional birth attendants or women specially designated in the community. Less often, it is carried out by midwives and doctors.
2.4 In terms of the barriers to identification and intervention, please see our response above to Question 1.
3. What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co- operation be improved?
166 3.1 Before responding to this question, FPA and Brook believe that it is imperative to recognise that professionals and agencies should be trained and informed to recognise the warning signs and appropriate protocols for following these up. Specific areas for action include:
• Timescale: If a girl is taken abroad to have FGM performed, there may be a very short time between planning the trip and the trip taking place. Early warning signs of such a trip happening must be acted on immediately.
• Family circumstances: If a mother, aunt, or sister has suffered FGM then the likelihood is much greater for younger female relatives. Professionals must be aware that, even when they have been unable to prevent FGM happening to one member of a family there may be other family members at risk, and in this situation there needs to be a concerted effort to educate the decision-making members of the family (usually the parents) in order to change their minds.
• Community pressure: It may be the case that, even where individual parents or families would prefer not to practise FGM, community pressure to undertake this practice is too hard to resist. Although professionals should focus on individual and family education and intervention, they should ensure that they combine this with broader education and information aimed at practising communities as a whole. This could be integrated with a more widespread consultation and campaign aimed at eliminating FGM.
• Identifying specific communities: The exact distribution of FGM-practising communities in the UK is currently very difficult to ascertain. In order to tackle the problem of FGM effectively, it will be important to undertake a thorough local data collection exercise which identifies the location of all relevant communities, and which then informs and educates health, social, educational and legal services in the relevant areas and local authorities.
3.2 With regards to the respective roles of professionals, FPA and Brook recommend the following courses of action:
• Health services: Maternity services are usually the first point of contact with the NHS for women who have undergone FGM, and relevant professionals must therefore be trained and informed to recognise the warning signs and appropriate protocols, as described above.
• Education: Schools are the best place to identify at risk populations and to protect girls from FGM, particularly through sex and relationship education which appropriately informs pupils of their rights in this regard.
Children and adolescents who have undergone FGM may face many physical, psychological or social adjustment difficulties that need to be addressed by teachers, school nurses and education welfare officers. Again, this indicates the need for educational professionals to be trained and informed to recognise the warning signs and appropriate protocols regarding FGM, as described above.
• Social services: Social services departments may not become aware of issues of FGM unless there is conflict within the family. However appropriately sensitised and trained social workers could become effective outreach workers as they may already interact with families from practising communities who are seeking other social services and benefits.
167 Social services also have responsibility for child protection; social workers will need training to identify children at risk and provide appropriate monitoring that serves to protect children while not removing them from the home.
• Children’s charities: Children’s charities can play a crucial role in providing positive support and services to families from practicing communities and creating a self help strategy where families (and particularly mothers) become the protectors of their own children.
For example, both FPA and Brook have long histories in both England and Wales of working with minority ethnic communities such as South Asian women, and with vulnerable young people, including with Somali communities with specific regards to FGM. FPA has also worked with refugee and asylum seekers on similar issues.
The main aim of our respective work programmes work in this respect is to build resilience in young people so that they develop the self esteem needed to have good sexual health.
FPA have also found our Speakeasy2 model to be instrumental in forging relationships and enabling best practice on the part of parents, including within Somali and other BME communities. For example, through their trusted relationships with mosque leaders, Speakeasy facilitators have been able to run courses within local mosques.
• Law enforcement: Police and other law enforcement agencies require training on the issue, which puts FGM in the arena of gender violence so that they are able to deal with cases that may come to their attention with sensitivity and firmness.
• Legal Aid: Refugees and asylum seekers often use legal aid as part of their attempt to secure residency in the UK. Ensuring that relevant legal aid professionals have ready information on the law regarding FGM and how it may
2 Speakeasy2 is a FPA course for parents and carers to better enable them to engage with the children for which they are responsible, on the often tricky issues of sex and relationships. FPA knows that many parents and carers want to talk with their children about issues associated with growing up, including sex and relationships, but many are embarrassed or unsure about where to start and what to say.
We have developed the Speakeasy programme to enable parents and carers to develop the skills, knowledge and confidence to have these sometimes difficult conversations. The community-based project runs over eight weeks and covers factual information about puberty, contraception and sexually transmitted infections. It also covers issues such as how to keep children and young people safe; the pressures young people may be under; and strategies for proactively starting discussions on growing up, sex and relationships. The course is accredited by the Open College Network, which gives parents the opportunity to receive credits for the work they do, which they can then apply in further learning or in employment.
Evaluations of the project have demonstrated the positive impact it has on parents’ knowledge, confidence and their relationships with their children. A Social Return on Investment (SROI) analysis of the programme has estimated the total value of benefits to children and parents and to the state to be £21 million. The value to the state represents a return of £5.29 for every pound of public money invested in the project.
Further information on Speakeasy: http://www.fpa.org.uk/communityprojects/parentsandcarers
168 affect a refugee’s status may be useful in preventing families from sending their daughters abroad for FGM.
• Immigration: Immigration officers should be aware of the countries where FGM is still practised, and should be able to identify children who have suffered FGM. Where this is identified, children should then be offered appropriate counselling and treatment, and the subsequent package of support and reception prepared for them should be tailored to take their experience of FGM into account.
For newcomers to the UK there are also refugee and asylum seeker agencies that are primarily responsible for helping individuals, families and communities adjust to their new environment and get access to services. Again, it follows that such agencies are aware of the warning signs and appropriate protocol re FGM as described above.
4. How can the available support and services be improved for women and girls in the UK who have suffered FGM?
4.1 FPA and Brook will respond to this question both from the point of view of improving support and services both for those who have suffered FGM, and for those who are at risk of suffering FGM, because the relationships between mother and child, and the cultural tradition of FGM mean that these aspects are often entwined.
4.2 In order to prevent future instances of FGM we believe that wherever possible the aim must be to work in partnership with parents and families to protect children through parents’ awareness of the harm caused to the child. We believe that there is scope to improve availability of support specifically targeted at parents from communities which traditionally practise FGM.
4.3 This will be particularly relevant for local authorities in which there are high populations of these communities, and is an important means of educating and supporting both mothers and fathers to resist the tradition of FGM and to break the cycle of this practice continuing into younger generations. Mothers who have themselves experienced FGM may also benefit from counselling as part of this specialist support.
4.4 Local authorities will benefit from the expertise within the voluntary and community sectors in order to develop such services, and should also work directly with the targeted communities to ensure a coherent and sensitive approach.
4.5 Appropriate authorities will also need to draw up protocols to ensure that situations which fall into this category are dealt with in a consistent and sensitive manner.
4.6 Key pointers for improving support and services for women and girls:
• Women are the key stakeholders of change in FGM practice and are therefore the best agents for reaching-out to the rest of the community including men, religious leaders and others. Changing women’s consciousness and providing them with self-empowering tools to take action is the fastest and more effective approach to stopping the practice. Attempts to stop the practice by focusing primarily on religious leaders, health professionals, circumcisers and traditional village leaders are much less successful than empowering women.
169
• Train service providers on how best to handle families from at-risk communities in a way that addresses their needs, protects their rights as well as dissuades them from continuing the practice. Service providers can also be trained to collect data to monitor progress within the information routinely gathered by their agencies.
Furthermore, and as outlined above, FGM can happen quickly and with little warning to the girl that this is going to happen, even when this involves taking her outside the UK. If a professional suspects that a child is at risk of FGM or has suffered FGM, it is imperative that this information is shared to ensure either early and effective intervention, or appropriate medical treatment and counselling if the procedure has already taken place.
• Engage individuals and groups from within the communities concerned in a constructive manner as the primary actors to stop the practice from within their own culture. This has the potential of turning community groups from enemies of the state to allies and the main beneficiaries from the change.
For more information please contact:
Harry Walker Policy and Parliamentary Manager
170 Written evidence submitted by NAHT
1 NAHT is an independent trade union and professional association with 28,500 members in England, Wales and Northern Ireland. Members include head teachers, deputies, assistant head teachers, bursars and school business managers. They hold leadership positions in early years, primary, special, secondary and independent schools, sixth form colleges, outdoor education centres, pupil referral units, social services establishments and other educational settings. The membership represents leaders in 85 per cent of primary, 40 per cent of secondary and virtually all special schools in England, Wales and Northern Ireland
2. Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
2.1) The information available to schools identifies those areas of the world where FGM is commonly practised, the inference being that girls and young women whose antecedents lie in those areas are most at risk. 2.2) This is useful to a point but incurs the risk of stereotyping certain groups and schools need to show considerable sensitivity in approaching the matter. The perception may be that there is a prospect being accused of being racist. The advice NAHT has written for members on FGM includes a comment from the campaigning group ‘Forward’ : ‘Do not let labels of 'tradition' 'culture' 'religion' or a fear of being called a 'racist' stop you from taking action to protect girls at risk of FGM, it is a violation of human rights’. NAHT believes that this is a fundamental point that needs to underpin discussion and guidance. 2.3) Our perception is that many schools are ignorant about FGM. This is not intended to be a pejorative comment but highlights the crucial need for action to be taken to rectify the situation. NAHT has attempted to contribute to this by producing an advice document for members. 2.4) This is not to say that accurate and comprehensive sources of information are not available, rather that they have not been signposted to schools. NAHT’s sampling of Local Safeguarding Children Boards’ coverage of FGM concludes that although reference is made to FGM it tends to be somewhat scant. We have, however, seen some excellent practice and would wish to highlight the leaflet produced for schools in Bristol as an exemplar of good practice.
3) What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi- agency co-operation be improved?
3.1) NAHT has called for the government, as a matter of urgency, to update its multi- agency advice document with particular reference to the chapter devoted to schools. It makes reference to curriculum content and structures that will disappear as a consequence of the reform of the national curriculum. The document has much to commend it including content on identification of FGM victims. As a first step we would like to see an updated version sent to all schools in England accompanied by a letter from the Secretary of State. 3.2) The nature and scale of FGM is such that no one agency can tackle it on its own. NAHT believes that the new relationships between the education, social care
171 and health sectors provides an ideal opportunity to identify and define joint working arrangements with regard to FGM. The association further believes that Public Health England has a key role to play, particularly given its commitment to improving the well-being of children and young people in the process. 3.3) The key to successful multi-agency work is not merely creating effective structures but improving identification both of those at risk and victims. Schools, to do this, need greater awareness and understanding of FGM; greater clarity from safeguarding boards and resources and training to include FGM in Personal. Social and Health Education provision. 3.4) NAHT believes that the voluntary sector is leading the way currently. Our advice document to members recommends that they supplement it with materials produced by ‘Forward’ and the Royal College of Midwives. The depth of knowledge and expertise possessed by these and other bodies is a rich resource. Groups such as ‘Forward’ have close ties with ‘at risk’ groups and this adds further richness to that which they offer.
4) How can the systems for collecting and sharing information on FGM be improved?
4.1) It is important to define ‘information’. NAHT’s evidence thus far alludes to the factual information and its interpretation that schools and other agencies need within which to frame effective policies, procedures and responses. 4.2) ‘Information’ can also encompass ‘soft’ data in the sense of sharing suspicions and concerns and the harder data of specific evidence of incidence. NAHT contends that all the connotations of ‘information’ need to be addressed in developing effective, co-ordinated multi-agency responses to FGM. 4.3) From the perspective of schools, NAHT believes that the vast majority of schools have effective safeguarding practices and would clearly identify FGM as being a safeguarding issue. The association suggests that its exploration of the coverage of FGM in LSCB documentation needs to be taken forward at a national level to ensure that FGM is given due prominence and that there is consistency between areas. 4.4) The first definition of information – dissemination of relevant and accurate factual material, accompanied by focused training– assumes a crucial role therefore in strengthening the ability to recognise abuse.
5) How effective are existing efforts to raise awareness of FGM?
5.1) The extent to which the Guardian’s campaign and its associated petition have ‘taken off’ is evidence of a perception that efforts to date have been ineffective. 5.2) Although particular organisations have sought to raise awareness we appear to be in situation where those involved in the work are in conversation with others so- involved. 5.3) The higher profile given to FGM in some quarters of the media and the increased awareness it has engendered must not be allowed to be a temporary phenomenon and NAHT urges the government to show leadership in developing a systematic and embedded response. The association notes the lead taken by the Scottish government in this respect.
172 Written evidence submitted by the London Borough of Newham
No declaration of interest to declare
1. Overview
1.1. The London Borough of Newham has just commissioned a Female Genital Mutilation (FGM) Prevention Services, which is, to our knowledge, the first of its kind. The following evidence outlines the service and some of the lessons we have learnt in commissioning it. This includes the importance of providing specialist support services for victims of FGM.
2. Background: The London Borough of Newham
2.1. Newham is one of the youngest and most diverse local authorities in the UK, with 83% of the population identifying as BAME (Black, Asian and Minority Ethnic). The 2011 Census identified 256,468, BAME residents in Newham, while the 2011 Newham Household panel survey found 30% of residents living in the borough were born outside the UK. This diversity provides Newham with a wealth of opportunities and at times, particular challenges.
2.2. Newham has historically had high levels of domestic violence (DV) reported to the police. While the volume of reported DV incidents fluctuates, Newham currently is the highest volume Borough in London. DV is flagged in 26% of all violent against the person offences reported in the Borough. Due to our unique and diverse population, Newham faces a range of violence against women and girls issues that require specialist support and innovative partnership work.
2.3. Because of the demographics of Newham, we would expect to see high numbers of recorded female genital mutilation; however, this is not the case. According to Newham Children Safeguarding data, there were only 6 recorded cases of FGM in Newham in 2013, and 5 reported to the Police. However, in 2007 the Foundation for Women’s Health and Development in collaboration with the London School of Hygiene and Tropical Medicine estimate that the number of maternities to women with FGM in Newham from
173 2001-2004 was 6.7%- 7.19% per annum. Using these estimates in 2012 there were between 435-467 births in Newham from women who have undergone FGM, and in turn, whose children are at risk of FGM. This means Newham has one of the highest estimates of residents who have experienced FGM in London. This massive discrepancy in data highlights the need to work with at risk communities to increase reporting for support (voluntary or statutory support) and the need for greater understanding among professionals in supporting FGM victims.
3. What Newham is Doing?
3.1. In 2013, the London Borough of Newham was awarded London Crime Prevention Funding to provide a One Stop Shop support service to victims of violence against women and girls (VAWG), this includes domestic violence, sexual violence, so-called ‘honour’-based violence, forced marriage, exiting sex work and female genital mutilation. With this funding we have brought a range of VAWG specialist support services in to one premise, under the umbrella ‘One Stop Shop’. While the services maintain their independence, they share advertising, building space and developing awareness raising in the community.
3.2. This change in service delivery was due to our consultations with victims of VAWG in Newham, who told us that most women experienced great difficulties in accessing help. With little knowledge of the kind of help available, their help-seeking was often a lengthy process. Women spoke about a lack of understanding about what services could and couldn’t do and, indeed, about what they had a right to expect. Additionally, professionals in the Borough recommended that Newham develop a Single Point of Contact to refer all VAWG cases to.
3.3. The One Stop Shop serves as the single point of contact for victims and professionals accessing DSV services in Newham. The One Stop Shop is open from 9 AM- 6 PM Monday- Friday, Thursday 9 AM- 8PM. The One Stop Shop includes a FGM Service, Exiting Sex Work Service, a Domestic and Sexual Violence Service and additional services are available such as a DSV Housing Officer, Solicitors and the non-uniformed Police. The phone number
174 for the One Stop Shop is a 24 hour line, ran by staff and by volunteers who are able to support victims in many different languages including Hindi, Punjabi, Urdu, Tamil, Bengali, Sylheti and Gujerati. To better understand service delivery in Newham and the One Stop Shop please see Appendix 1.
4. The Newham FGM Prevention Service
4.1. The FGM Prevention service is one of many services that sit within the One Stop Shop. The service is commissioned to intervene when health professionals first become aware of FGM (normally during routine examinations in pregnancy). When a professional in Maternity becomes aware of a mother who is a victim of FGM, they are required to make a referral to safeguarding due to child protection issues for the unborn child, and at the same time, invite the woman to access the FGM Prevention Service. This service supports victims of FGM to empower them to understand the negative consequences of FGM and not allow FGM for their daughters.
4.2. The FGM Prevention Service contract is £80,000 per annum for four years (£320,000 contract). The London Borough of Newham provides the cost of the premise, utilities and ICT.
4.3. The FGM Service will provide the following: • Casework advocacy for 50 victims per year. • Interventions to extended family and spouses where appropriate, • Training for 20 Community based FGM Champions per annum. • Support for victims to report DSV to the police. • A service to male allies. An in-depth screening process will occur before advice is offered to male allies. • 20 seminars to antenatal services, health visitors, GPs, education, children services and police professionals regarding FGM, providing training to a minimum of 200 professionals per annum. • The development, implementation and management of a FGM Steering Group that is a subgroup to the DV Forum.
175 • 10 community events on the subject of FGM per year to facilitate awareness raising, safeguarding issue of FGM and challenge cultural acceptance of FGM. • Support for professionals in making referrals to safeguarding for FGM. • Empowerment for victims to understand that criminal justice services can protect their daughters and prosecute those that carry out FGM. • An FGM survivors support group, engaging at least 30 individual women per annum. • Support for 4 DSV community awareness raising events. These events will facilitate awareness raising campaigns, dialogues and community participation in the service and will be joint events delivered by the One Stop Shop contracted services. • Support for the LBN to gather intelligence on trends and issues in the Borough related to this client group.
4.4. Due to procurement rules, at the time of submitting this evidence, Newham is not in the position to announce who the provider for the FGM Prevention Service, although we can confirm service will begin implementation by the end of February 2014.
4.5. Outcomes for the service will include Outcomes Female Genital Mutilation Services Newham
Outcome Measure 2013/14 2014/2015 2015/16 2016/17 Baseline target Target Target Commentary
Improved Increased Baseline 10% 15% 20% This will be identification identification of established increase increase increase measured of Domestic domestic on referral referral referral through Violence in violence risk in Children’s rate from rate from rate from increased in Safeguarding safeguarding Case 2013/14 2013/14 2013/14 recognised children triage Manageme DSV cases referrals. nt system through the Children’s triage system (MASH).
Increase Baseline Increase increase increase This will be contacts with established contact by contact by contact measured adult victims of via Adults 10% from 15% from by 20% through
176 Female Genital Case 2013/14 2013/14 from increased in Mutilation Manageme baseline baseline 2013/14 recognised nt System baseline FGM
Reduce Increase in baseline 5% 10% 15% We will ask number of referrals of FGM established increase increase increase services to victims of to the police referral referral from monitor the repeat DV rate from rate from 2013/14 number of after 2013/14 2013/14 referrals they accessing send to the services police. It will be the responsibility of the agencies to support victims to report to the police
5. Early Lessons from Implementing a FGM Prevention Service
5.1. To our knowledge, Newham is the first local authority to commission a FGM Prevention Service of this scale. Because of this, understandably the market for commissioning FGM services is quite small and under developed. Small services and community groups that had experience in delivering support to victims of FGM were not able to meet other legal commissioning requirements such as high insurance levels, relevant policies and an understanding of the procurement process.
5.2. Community Development funding would support FGM communities to increase FGM prevention services from the ground up. It became clear throughout the commissioning process that grassroots based organisations were best placed to support victims of FGM and challenge community members to prevent FGM. If given the chance with Community Development funding, over time these organisations would grow and eventually be able to apply for larger contracts, such as the one Newham has commissioned.
177 5.3. Additionally, it became clear throughout the commissioning process that support mainstream statutory services can provide to prevent FGM needs to be clarified. For example, rightfully so, campaigners are urging FGM to be recognised as a child protection issue and all potential victims should be referred to Children’s Social Care. However, if there is no longer an ongoing risk to the child, victims and potential victims of FGM, may not always meet the threshold for support from Children’s Social Care, but will be referred to other services such as Children’s & Adolescent Mental Health Services for ongoing support.
5.4. There are many positive aspects to commissioning FGM Prevention services, most importantly an increase in risk identification for children at risk of FGM. However, referrals to statutory services alone will not prevent FGM. Consultation with professionals highlighted the concern that many would not know how to support a victim of FGM, as health services focus is the health of the mother and child at the time of pregnancy and clinical interventions, Children’s Social Care focus will be the concern around the child, and the Police’s focus will be around the criminal investigation. This may leave the woman who has experienced abuse without long term resources to support her to prevent FGM. Support for victims of FGM and awareness raising from a grassroots level within the community are vital aspects of preventing FGM for future generations.
Point of future contact: Kieran Read, Head of Public Policy and Research, London Borough of Newham Kelly Simmons, Domestic and Sexual Violence Commissioner, London Borough of Newham
178 Appendix 1
Newham One Stop Shop
179 Written evidence submitted by Professor Sarah Creighton
Complex Gynaecological Conditions in Women with FGM
1. We wish to highlight the fact that services for women with FGM suffering with complex gynaecological problems are not satisfactory. Whilst there are increasing efforts to provide specialist services for pregnant women with FGM, many of these services only see pregnant women. Even where non- pregnant women are seen, there are no clear referral pathways for direct referral to specialist gynaecological clinics.
2. Gynaecological problems include pain or difficulty with sexual intercourse and bladder problems such as incontinence and prolapse. In addition psychological and psychosexual support services for existing clinics are very limited. Whilst many of these health problems are not specific to FGM, FGM can have an impact on both the presentation of symptoms and type of treatment requires. They should be managed by clinicians familiar with FGM.
3. Women with FGM find it very difficult to access specialist gynaecology services such as urogynaecology. This may be not due just to their FGM but also to other associated factors which act as barriers to access to health care such as low income, poor or no English, legal status etc.
4. It is essential that women with FGM have equal access to the existing evidence- based high quality care the NHS is already providing for complex gynaecological conditions. However, in reality, women with FGM often do not know that there is help available for them. They may visit their GP if they are in distress and pain but referral to a general gynaecologist untrained in FGM may mean that they do not get the help that they need.
5. Suggestions include
• Education of GPs about the gynaecological aspects of FGM so they can assess and refer on appropriately • Setting up clear referral pathways from existing FGM services allowing referral directly to specialised gynaecology services without insisting patients go back to their GP to ask for a referral. • Ensuring that FGM is included in the syllabus for training specialist urogynaecology consultants. This could be done via the Royal College of Obstetricians and Gynaecologists. • Updating current Urogynaecology consultants on FGM. This could be done via the British Society for Urogynaecology. • Highlighting FGM to the Complex Gynaecology CRG for consideration for inclusion in urogynaecology service specifications. • Including gynaecological symptoms in health education and public awareness campaigns about FGM to encourage women to be more proactive and seek help.
180 Authors
Juliet Albert
Sarah Creighton
Declaration of Interests
Juliet Albert is a Specialist Midwife at Queen Charlotte’s and Acton African Well Women Service. She is a member of the FGM National Clinical Group
Sarah Creighton is a consultant gynaecologist and honorary clinical professor at University College Hospital London. She is a past and founder member of the FGM National Clinical Group
181 Written evidence submitted by Guardian News & Media
ABOUT GUARDIAN NEWS & MEDIA
1. Guardian News & Media is the publisher of theguardian.com and the Guardian and Observer newspapers. It is the core business of Guardian Media Group, which is wholly owned by The Scott Trust Ltd, the purpose of which is to secure the financial and editorial independence of the Guardian in perpetuity.
OVERVIEW
2. The Guardian and Observer have been reporting on female genital mutilation for over fourteen years. Female genital mutilation is a horrific crime inflicted on young girls in Britain. Female genital mutilation, or FGM, is child abuse. Victims of FGM suffer every day from severe physical and mental health problems after ‘cutting’, including potentially fatal complications during childbirth. Recent estimates suggest that 66,000 women in Britain have suffered FGM, the highest of any member state of the European Union, and that 24,000 young women and girls are at risk from this cruel procedure. 3. FGM was outlawed in the UK in 1985, but since that time there have been no prosecutions. Despite FGM being made illegal, the UK continues to have a fragmented and incoherent approach to tackling this issue.
OUR POSITION
4. The Guardian welcomes steps taken by the Crown Prosecution Service and Police and Crime Commissioners to prioritise the issue of FGM, and steps taken by government ministers who have signed the declaration to end FGM in the UK to mark the International Day of Zero Tolerance to FGM.
5. We also applaud the announcement that NHS staff will be required to record cases of FGM and to submit information to the Department of Health. Additional steps by the Home office to fund community engagement initiatives on FGM and the Department for International Development’s work to lead a group of anti-FGM activists ‘to deliver a global campaign to end FGM’ is also welcome. We recognise the importance of raising awareness about the tragic consequences of this practice in communities in which it is most deeply embedded.
6. The one area where activity is absent is in the field of education. Schools can play an essential role in fighting FGM by identifying potential victims and raising awareness about the cruel realities of the practice. Many girls will be sent abroad to be mutilated during the holidays, so action on this issue is essential. Ofsted had promised action on this issue, but it never materialised. That’s why the Guardian’s has worked with 17-year-old Fahma Mohamed from Bristol, to launch a petition calling on Michael Gove, in his role as Secretary of State for Education, to write to headteachers before the summer holidays1 to take every action necessary to protect every child in their school at risk of female genital mutilation. This approach has already been announced by the Scottish government2, and we urge Mr. Gove to follow this example.
7. Gladys Berry, the headteacher of Highbury Fields school in London, which ran a programme of lessons with pupils last year, said: "Headteachers need a letter from the Department of Education;
1 http://www.change.org/petitions/educationgovuk-tell-schools-to-teach-risks-of-female-genital-mutilation- before-the-summer-endfgm 2 http://www.theguardian.com/society/2014/feb/07/female-genital-mutilation-scotland-schools-headteacher- fgm
182 some will be anxious about the reaction from different parts of the community so they need to feel that it is appropriate and necessary to teach FGM in their school.”3
3 http://www.theguardian.com/society/2014/feb/07/female-genital-mutilation-scotland-schools-headteacher- fgm
183 Written evidence submitted by Tony Lloyd, Greater Manchester PCC
I was encouraged to hear that the Home Affairs Select Committee will be undertaking an inquiry into Female Genital Mutilation (and hope you find the information contained within this letter useful to the work you are undertaking).
The first question your inquiry poses asks about the effectiveness of the current legislative framework around FGM and what are the barriers to a successful prosecution. Whilst I believe that there are indeed barriers in terms of progressing a successful prosecution, what has been reinforced from the work that my Office has been undertaking with local Somali Women’s groups is that these barriers are more cultural than legislative in nature. We have had legislation in this country since 1985, yet there have been no convictions. Indeed, even when the legislation was strengthened in 2003, this made no difference to the number of convictions.
A legal framework that clearly states that female genital mutilation is unacceptable is undeniably an important and necessary measure for contributing to the end of this practice. However without evidence that FGM will be robustly prosecuted, the law’s effect is nullified. When laws that ban the practice are introduced in contexts where people are still expected to engage in the practice and fear social punishment if they do not, the practice will continue and may be driven underground. Our challenge is therefore to develop, introduce and implement legislation in ways that contribute to a social change process that influences the communities involved, to abandon (or at least challenge) the practice. If there is a genuine prospect of children being taken into care and the “cutters” sent to prison, a rigorously enforced FGM law would have a significant deterrent effect. Sentencing guidelines should emphasise the availability of significantly reduced sentences for former cutters or parents who co-operate with authorities and the police could make better use of intelligence-led police operations and surveillance, particularly against "cutters". However, currently there is no evidence that this is happening in the criminal justice system and we may be guilty of relying on “survivors” who have not pursued a prosecution to champion the fight against FGM, rather than the legislation itself.
Clearly, legislation has not worked and will not work on its own and should be accompanied by a broader programme that includes human rights education, community dialogue and partnership working. From consultation with our Greater Manchester FGM forum and local groups, it is apparent that within those communities where FGM is most prevalent, there is little or no recognition (or indeed acknowledgement) that the practice carries such a severe penalty. Indeed, even when the legislation is understood, cultural barriers in relation to challenging a family member are so great, that reports are rare.
Even when a report is made, pursuing a prosecution is problematic. A high burden is placed on witnesses (often young girls) and requires them to testify against their parents and/or family members-probably with no family support. In addition, there are difficulties in terms of detection in that, although the
184 physical marks left on victims means that detection could be straightforward, this is only at the cost of a gross invasion of the privacy of the girls in question and requires their trust in local services to provide them with appropriate and sensitive support. A lot more needs to be done to secure this trust. We also need to be mindful that victims may not ask for help because they don’t actually realise they need it.
I have asked my Office to get involved in some community engagement work with one of our local Somali communities here in Greater Manchester and on one occasion, a member the team was privy to a debate with some community members, half of whom acknowledged that FGM was against the law and do not currently practice, whilst the rest of the group expressed the belief that this was a practice that was encouraged in the Koran and one which would ensure their daughter was cleansed and devoid of promiscuity, in advance of making her available for marriage. It could be questioned whether legislation would have any impact on this group in terms of the choices they make for their daughters, regarding FGM. FGM is considered by some to be a necessary step to enable girls to become women and to be socially accepted, together with the rest of the family. Families and individuals uphold the practice because they believe that their group or society expects them to do so and they expect that they will suffer social sanctions if they do not. In this context, if individual families were to stop this practice on their own they fear they would harm the marriage prospects of their daughter as well as the status of the family. Ending FGM will require a process of social change that enables communities and individuals to challenge this practice and develop a critical approach. That will be a huge culture change.
Police officers tell us that there is little awareness of the issue within current policing procedures and practices and minimal training, but probably more significant to this debate, there is an acknowledged lack of confidence by many police officers that they would actually know how to respond sensitively, if a report did come in.
Regarding the question you pose in relation to which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention, The Royal College of Midwives report estimated that over 20,000 girls under the age of 15 are at risk of FGM in the UK each year, and that 66,000 women in the UK are living with the consequences of FGM (2013). However, it is probably more realistic to say that the true extent of those at risk is unknown due to the 'hidden' nature of the crime. We know that girls may be taken to countries of family origin so that FGM can be carried out during the summer holidays, allowing them time to 'heal' before they return to school. There are also worries that some girls may have FGM performed in the UK and I would welcome further investigation as to whether this risk does exist, or whether the main risk is for those girls who are taken on “holiday”. It is essential that any national response that is developed is based around this knowledge.
In Greater Manchester, we have a Greater Manchester FGM forum, which has representation from both partner agencies (health, police, community
185 safety) and the voluntary and community sector. From conversations at this forum, it appears that the girls who are at most risk are from African or Middle Eastern heritage but we also have to allow for the fact that this practice may not be unique to those well defined communities. Conversations would also suggest that in Greater Manchester, FGM tends to occur in areas with larger populations of communities from these areas and in particular first-generation immigrants, refugees and asylum seekers. Again though, these assumptions are based on conversations with communities and agencies practicing in those particular communities, rather than any scientific research and maybe this is one knowledge gap which your inquiry could seek to address.
Based on what I have described so far within this submission, there are clearly opportunities for partnership working and one of the most important elements of this work I feel, is to let some of this work be directed by the communities themselves. (Rather than telling communities “we want to raise awareness”, ask them about their feelings regarding FGM). Undoubtedly there will be some resistance, due to the contentious and sensitive nature of the subject and any awareness raising work will only be successful if communities themselves feel empowered and engaged with partner agencies. Awareness raising in schools is something that I have encouraged in one particular area of Greater Manchester, however this has been done on an informal basis, by local parents, who know their local community and understand the issues. Unfortunately, it will be difficult to test the immediate impact that this type of true community work has on FGM practice, but having spoken to people within those communities who are committed to working against FGM, they inform me that it is small, subtle steps like this that they feel will have the biggest impact in the long term. Whether that is the case, remains to be seen.
I am also aware that early conversations with local religious leaders are underway in this community, to attempt to align the work that has started in schools with the local community. The group has also had visits from local community midwives and health visitors. In another part of Greater Manchester, FGM clinics are running, which provide emotional and well- being support to those women who are experiencing the long term effects of FGM. Through engaging with people who attend these clinics we are able to understand more about the long term impact that FGM has on issues such as self-esteem and confidence, both of which impact in the long term on a person’s ability to fully integrate and become independent. However, these are very small localised projects and unfortunately FGM is very much hidden from mainstream support services, which means that although commendable, existing efforts to raise awareness of FGM are minimal.
Additional work that has been suggested to us in our community consultation is better awareness raising for both health professionals and also teenage girls around what their bodies should look like and what your responsibilities in looking after your health should be. Because girls are generally very young when they have the FGM procedure, the visible scars are not recognised as such and are often seen as a “normal” part of their anatomy. By understanding what the female anatomy should look like may help older girls
186 to seek help before health crises occur. This may result in a less long term impact on their sexual and gynaecological health in the future. Young women also need to be encouraged to keep their cervical smear appointments. Current evidence suggests that people from a Black and Minority Ethnic background are underrepresented in the attendance rates for these appointments, which would provide another opportunity to seek advice and support. In addition to being able to refer to appointments for a clinical intervention, gynaecological appointments should also provide an opportunity to identify health problems at an earlier stage and prevent long term health issues. In addition, and despite some local advances in health clinical practice, we have been made aware from discussions with some community members that there is a lack of support available from a health perspective when a person does disclose, unless this is in the form of a clinical intervention such di-infibulation. Where emotional support is required, this is scant. Opportunities in terms of both the training of front line clinicians regarding recognising and responding to the signs of FGM, but also in relation to improving information sharing protocols with criminal justice agencies cannot be overlooked.
There are clear opportunities for health professionals in helping us to better understand the prevalence of FGM and we need to explore how health colleagues could share more information on victims of female genital mutilation with police and social services, in order for a picture to be built of the true scale of the practice. Currently, hospitals do not have to pass on vital information to the police.
The key to successful intervention in terms of addressing FGM needs to start within those communities who practice the procedure. By engaging with these communities, health and criminal justice professionals will develop a much more comprehensive understanding of the issues. There may also be opportunities to work with port staff, however this would need to be carefully monitored so as to not bring with it more cultural barriers. Any media campaign would need to be carefully managed, so as to not push the problem more underground than it is already. In addition, a media campaign should seek to address the many different levels of FGM and seek to offer support, rather than to ostracise those communities who may already feel under pressure. For example, we would not want certain political groups to use the campaign as another means by which to victimise and isolate certain communities.
I am confident that good practice does exist and we should be emulating this in our own work. When your inquiry concludes, it would be useful to receive some good practice guidelines that we can share with both partners and our communities that will enable us to collectively tackle this really important issue.
I hope you find the information useful, please do not hesitate to contact me if you require anything further.
Tony Lloyd, Greater Manchester PCC
187 Written evidence submitted by Dr Comfort Momoh MBE
FGM is a very complex issue for both girls and women and I wish to emphasize that the current services for women and girls who have undergone FGM is not acceptable.
It is essential to have background knowledge of the distinctive features of the culture, values and beliefs of each community. This in turn will help us to fully engage with the community with the hope of changing long held attitude and mind-set.
♦ The Committee’s inquiry should consider more work with the communities and churches.
♦ The fact that frontline providers do not have adequate knowledge to deal or care for women and girls sensitively is worrying and there are no clear pathways for clinicians.
♦ The fact that GPs (first point of call) do not have adequate knowledge of FGM (this is evident from the resent survey I did looking at GPs knowledge of FGM).
♦ FGM should be part of core – curriculum and mandatory training for all professionals including teachers.
♦ Health Visitors and Social Workers need direction and all need to know and be aware what their roles and responsibilities should be in safeguarding girls who are at risk of FGM (national standards).
♦ Midwives should as all women about FGM during antenatal booking so that an agreed plan of action for pregnancy, Labour and post-delivery would be recorded in her note.
♦ Regarding all FGM women to Social Services – Social Services need to be well trained in this area to prevent any women and community going underground and not willing to talk about their FGM as they might see this action as been penalised.
188 ♦ The African Well Woman’s Clinic at Guy’s and St Thomas pioneer work around FGM and we are proud to have been instrumental in training and helping other FGM clinics sprung We provide support, counselling, advice and de-infibulation to woman and girl.
♦ We work very closely with the government at local, national and at International level – advising and shaping policy.
No known conflict of interest with any of the above information. Author:- Dr Comfort Momoh (MBE) FGM/Public Health Specialist FGM National coordinator Guy’s and St Thomas Foundation Trust
189
Written evidence submitted by Lancashire Constabulary
Please find attached the request for consultation on FGM on behalf of Lancashire HBA/FM/FGM strategy group.
How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
• Regarding mutilation abroad UK criminal law applies to British National or settled children. • Clarity required regarding how to prove when someone is a British citizen at the time of the operation or what is classed as a long standing resident of Britain • In USA the legislation only covers children and this would seem more proportionate than taking action against “ cutter” who have performed op on a willing adult • Difficulty evidencing when an operation was actually performed. ( we had one that the parents said the op was done pre- 2003 and we couldn’t disprove this) • Professional paralysis – ie if the parents of a child are middle class and otherwise “ respectable” agencies are less minded to continue with an investigation ( however if the same parents had a daughter and had broken her leg would we see this in the same light?) • Education could be more proactive – ie when girls are taken out of school for prolonged periods are we culturally frightened to investigate the reason for the absence even where there may be clear suspicion • Legislative framework needs to be strengthened to send a clear message out to cutters/associated perpetrators, FGM will not be tolerated • Any legislative proceedings rely on information to prompt them. The current intelligence picture on cutters and victims is poor • Consideration an FGM prevention order for use in strictly controlled circumstances
Barriers are as follows:-
• Lack of reporting due to repercussions for victims. • Lack of awareness, knowledge, education • Particular communities think it is acceptable due to their culture/religion, • Victims are usually disempowered young women or girls that lack knowledge of how to make official complaints • Conflicting loyalties as often the perpetrators are their parents/relatives • Could affect social prospects and marriage prospects • Lack of evidence as done privately at home • Victim and her family could face ostracism • Threats of violence • Victims are unlikely to give evidence against their parents or relatives due to fear of losing them • A huge social pressure to keep silent within their communities
190
Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
• Somalians, Kenyans, Egyptians, Sudanese, Ethiopians, Malians • Usually the groups are from west Africa and north eastern regions of Africans • Lack of knowledge of FGM • Not knowing how to handle the situation • Being uncertain about the significance of cultural/ traditional values therefore being too culturally sensitive • Accusations of racism • Concerned about the confidentiality of the victim • Difficult to identify and prove who inflicted the injury and who may have been party to it as often it is due to community collusion which is deeply rooted in their society
What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
• Police; prevent and prosecute, encourage reporting • Health; identification and to disclose to the appropriate authorities, and to work jointly with partner agencies such as the police and social services. • Education/schools; to prevent and protect victims by speaking to teachers and parents/ awareness raising/ training/ campaigns/ publicity for all agencies • Third sector; protecting and supporting victims, support with reporting to the police, providing a safe place to stay such as a refuge • More multi agency meetings are required to tackle the issues.
How can the systems for collecting and sharing information on FGM be improved?
• Multi Agency Data Exchange • National product of intelligence around cutters and demographic info on communities likely to engage in FGM
How effective are existing efforts to raise awareness of FGM?
• Not effective. One reason may be due to cultural sensitivity and lack of knowledge of FGM and how to deal with the issues. • More campaign work, publicity and raising awareness is required with partner agencies/ religious leaders and communities • Specific funding to be made available to deal with the above
191 How can the available support and services be improved for women and girls in the UK who have suffered FGM?
• Dedicated ( confidential) helplines for victims • More funding for specialist workers on FGM. • Safe accommodation for victims • Greater emphasis on this subject in training midwives and health professionals • A key public figure ( film/ tv personality ) who has been victim of FGM could be used to champion a campaign to remove the stigma
Detective Chief Inspector Sue Cawley
Public Protection Unit Quality, Development & Compliance
Lancashire Constabulary
192 Written evidence submitted by Dr Deborah T Hodes
• There is a lack of understanding about the difference between the preventative approach and prosecution and they are getting confused. The dual approach needs to be in place.
• In the attempt for a prosecution the categories of neglect and physical abuse of the child as well as the FGM laws should be considered.
• There need to be a strong prevention campaign run from the Local Children’s Safeguarding Boards (LCSB) in all boroughs with posters in all health, education and community settings. There needs to be funding for community groups to run focus groups and education workshops for young unmarried women and men from practising communities so they understand what it is etc.
• In school, it needs to be taught in the context of citizenship so it makes sense to all participants from all communities i.e. not to break the law.
• It also needs to be understood in the context of our bodies and not mutilating them whether it’s FGM or labioplasty - a current vogue
• The government could highlight that there is a place in the child’s RED book of a woman with FGM, shown here. The Health Visitor must also have a statutory duty to ensure that the same information (including the mother’s FGM status) is on the mother and child’s GP computerised notes.
Deborah Hodes •
193 • The mother need to be put in touch with the community group that is supporting women not to allow FGM on their daughter and to understand that it is illegal and harmful etc. Knowing someone who has not been cut (UNICEF study 2013) has shown to be protective.
• With the above information, the prevention programme must be targeted to the mother and her family including her husband as it is shown that it is more effective when the husband understand what FGM involves, its illegality and the medical risks
• FGM should become a part of the mandatory training of all paediatricians and they should be taught how to ask the question.
• When there is a suspicion that a girl may go abroad to be cut then the parents should be informed and the girl examined by a paediatrician before she goes and when she returns. This will ensure the girl is not cut and if she is the parents can be prosecuted. Again there should be a low threshold for examining the girls as the examination done in the context of a health check by an experience paediatrician is not abusive. The RCPCH is doing a training DVD
• FGM should become part of all Level 3 safeguarding training in the intercollegiate guidelines for health professionals, including nursing training
• Given the numbers of women who have had FGM social care will be overloaded which is not in proportion to what has happened. Many will have had FGM before 2003 or before they arrive in the UK if it is after 2003. Any woman identified should be given information including the passport so they know now to have they girls cut.
• It needs to be acknowledged that identifying the Type of FGM is difficult and in the children I have seen most have no signs as they have had type IV.
There is no known conflict of interest with any of the above information.
Deborah Hodes Consultant Community Paediatrician University College Hospital, London and the Royal Free Hospital Trust, London Named doctor for child protection in Camden
194 Written evidence submitted by the Mayor of London’s Harmful Practices Taskforce
Introduction
1. The Mayor’s Office for Policing And Crime (MOPAC) welcomes this opportunity to provide a written submission to the Home Affairs Select Committee Inquiry into female genital mutilation (FGM). Tackling all forms of violence against women and girls (VAWG) including harmful practices such as FGM is one of the Mayor’s top priorities. As outlined in his revised VAWG strategy (2013-17), the Mayor has committed to deliver a pilot initiative aimed at improving the way London agencies identify and respond to FGM and other forms of harmful practices. For further details, please see the VAWG strategy at the link below: http://www.london.gov.uk/priorities/policing-crime/mission-priorities/violence- against-women-girls
2. This submission has been drafted by MOPAC on behalf of the Mayor’s Harmful Practices Taskforce. In his Police and Crime Plan (2013-16) the Mayor made a commitment to establish a Harmful Practices Taskforce in London to confront FGM, forced marriages, so-called witchcraft killings and “honour”-based violence. The Harmful Practices Taskforce includes representatives from key statutory partner agencies including the Metropolitan Police Service, Crown Prosecution Service, London Safeguarding Children Board, NHS England, London and key specialist voluntary and community sector organisations and professional organisations working on FGM and other forms of harmful practices. FGM is a key area of focus for the Taskforce. (Please see the appendix for a full list of agencies on the Taskforce). This submission was prepared in collaboration and agreement between partners on the Taskforce.
3. To accompany this written submission, MOPAC would also like to submit to the Home Affairs Select Committee a study into harmful practices undertaken by Imkaan on behalf of the Greater London Authority (GLA) in 2011. The issues highlighted in the attached report, ‘The Missing Link’ and its recommendations have informed our approach to FGM and other harmful practices in London.
4. Key questions for consideration by the Home Affairs Select Committee:
• How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK? • Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention? • What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved? • How can the systems for collecting and sharing information on FGM be improved? • How effective are existing efforts to raise awareness of FGM? • How can the available support and services be improved for women and girls in the UK who have suffered FGM?
5. How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
195 As the Home Affairs Select Committee is no doubt aware, no prosecutions have been brought under the legislation prohibiting FGM which has been in place since 1985. There are a number of barriers to achieving a successful prosecution. The first issue is that there are still too few cases that are referred onto the Crown Prosecution Service and the number of cases that are reported or referred onto the police remains very low.
As highlighted in the Missing Link report, identification of FGM is a significant problem and women and girls experience multiple barriers in reporting FGM. • Women and girls will not always identify or associate their experience with abuse, which are more likely to be framed within the context of family or community expectations rather than forms of violence or abuse. • The likelihood of detection is even more complex for young women who will be less aware of what is happening to them and have less access to external sources of support. • The consequences of reporting or seeking support include ostracism from the family and community, extreme levels of guilt about providing evidence against family members and the risk of on-going repercussions from family and community members. • There is a lack of understanding and awareness of FGM amongst frontline practitioners particularly within health, social services and education and a reluctance to intervene due to cultural sensitivity and agencies concerned about being seen as racist. This means that professionals are missing opportunities to identify girls at risk and prevent harmful practices. • A lack of education on FGM in schools and not enough community engagement initiatives to raise awareness of the law and to educate and empower women and girls to resist the practice and seek support and protection.
With such low numbers of reported FGM cases it is difficult to confirm whether there are any problems with the existing legislative framework. However, there are some issues that we would like to highlight:
• The existing legislation relies on children/victims to act as a witness. An over reliance on young girls to provide evidence against their families may be a barrier to prosecution. The onus should therefore be on professionals and agencies to gather enough evidence to proceed with an intelligence-led prosecution that does not rely on the victim’s attendance. Regardless of whether prosecutions rely on the victim or not, it is imperative that women and girls are protected and supported before, during and after any interaction with the criminal justice system. If they are required to support a prosecution it is vital that special measures are made available for vulnerable/intimidated witnesses as well as wrap-around support.
• There is a precedent for proceeding with prosecutions without relying on the victim in domestic violence cases. The CPS domestic violence guidelines make it clear that if a victim does not wish to proceed with the case, it will not be automatically stopped. The CPS will first consider whether it is possible to continue with the case without the victim’s evidence and where there is sufficient evidence they may decide to proceed without relying on the evidence of the victim at all. A similar policy and guidelines should be introduced for FGM cases whilst ensuring that the victim’s best interest is at the heart of the process. • The Taskforce recognises that prosecutions that are not supported by the victim are not straightforward and prosecuting without a victim’s consent is problematic. This
196 is particularly so when the victim is a minor and there are complex family dynamics to consider. We would urge the CPS to consider the merits of proceeding with a victimless prosecution on a case-by-case basis, in consultation with the victim, social care and any other support services working with the victim. Consideration needs to be given to the impact of prosecution on the victim’s life, the wishes of the victim and her human rights. If a decision is taken to proceed without the victim’s involvement, it is important that this is effectively communicated to the victim, explaining what will happen and why and ensuring that appropriate support is in place for the victim.
• There are limitations with the current legislation around some groups of migrant women and girls. The offences only apply if the mutilation has been done to a UK national or a permanent UK resident. Some cases that have been referred to the police have not been able to proceed because of the victim’s immigration status. This is a barrier that needs to be addressed.
• The FGM Act does not cover re-infibulation which occurs after a woman with FGM has given birth. The legislation states that a person is guilty of an offence if he ‘excises’,’ infibulates’, or ‘mutilates” which are all acts of removal/cutting but it does not mention the re-infibulation despite the fact that the World Health Organisation (WHO) has recommended that re-infibulation should not be undertaken under any circumstances and has provided guidance on how to re-suture women after giving birth.
• Another issue with the legislation is that the Act states that “no offence is committed by a registered medical practitioner who performs a surgical operation necessary for a girl's physical or mental health who is performing a surgical operation on a girl which is necessary for her physical or mental health.” However, the Act does not define what it means by ‘necessary for her physical or mental health’ and therefore leaves this to the discretion of medical practitioners who can interpret this as broadly as they wish. The Taskforce has particular concerns about how this section of the Act is interpreted and feels it presents a legal loophole which could allow medical practitioners, particularly those in the private cosmetic surgery industry, to perform acts of female genital mutilation with impunity. The Taskforce would recommend a review of the wording of this section of the legislation to ensure that there is clarity and guidance around the circumstances in which it is legal to perform such procedures particularly on minors.
• The Taskforce is also concerned that criminal activity such as FGM can sometimes be masked by legitimate activity. For instance, while circumcision is a legitimate and legal practice, there is a danger that in some establishments that perform circumcision it is possible that FGM may also be taking place. While we know that many families take their daughters abroad to carry out FGM, it is vital that consideration is given to establishments in the UK where FGM may also be taking place.
197
6. Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
According to UNICEF 3 million girls undergo FGM every year in Africa.1 Most women and girls affected live in 28 African countries and parts of the Middle East and Asia. The highest prevalence rates (90% or more) are found in Somalia, Sudan, Dijbouti, Egypt, Guinea and Sierra Leone. The forthcoming FGM prevalence study commissioned by the Government will provide an up-to-date picture on the groups that are most at risk in the UK.
As highlighted in the Intercollegiate recommendations for identifying, recording and reporting FGM,2 it is widely agreed that those at risk of FGM include: • Any female child born to a woman who has undergone FGM • Any female child whose older sibling has undergone FGM must be considered at immediate risk • Risk to other children in the woman’s or child’s household must also be considered
There are numerous barriers to identification and intervention as outlined above in section 5.
7. What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
The roles of all of the professionals outlined above are first and foremost to safeguard and protect girls from FGM and to ensure access to appropriate support and justice when FGM has already taken place. All agencies need to take a proactive approach to tackling FGM as a reactive approach will not enable effective identification and intervention as outlined above.
The Government’s multiagency practice guidelines on FGM clearly set out the role of all agencies concerned but the problem remains effective and consistent implementation of these guidelines. The Taskforce would suggest that consideration is given to making these guidelines statutory and holding agencies to account through the introduction of a reporting and oversight mechanism.
It is crucial that the emphasis is on a ‘whole system’ approach to prevent and respond to FGM so that frontline staff across all agencies (education, health, social care, criminal justice agencies, voluntary and community sector) are adequately trained and have the professional competence and skills to identify FGM and know how to report and refer on girls that are at risk. FGM needs to be embedded into relevant local authority and local NHS policies, strategic plans and child protection/safeguarding policies and procedures to drive a more consistent operational response. Multiagency partnership and coordination are key to ensuring that all partners are playing their part and are signed up to the same strategic aims.
1 United Nations Children’s Fund (2013), Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change, UNICEF, New York. 2 Tackling FGM in the UK: Intercollegiate recommendations for identifying, recording and reporting (1 November 2013) Published by the Royal College of Midwives
198 8. How can the systems for collecting and sharing information on FGM be improved?
The plans that have recently been announced by the Department of Health on recording, collating and sharing information will go some way to improving the identification of FGM and should hopefully provide, for the first time, a more accurate picture of the practice of FGM in the UK. However, the Mayor’s Harmful Practice Taskforce would like to go one step further than the current plans for mandatory recording of FGM and is calling for mandatory referrals/sharing of information on behalf of all health professionals that identify women or girls who have experienced FGM or who are at risk. We would also like to see these developments extended to other statutory agencies – most notably education.
9. How effective are existing efforts to raise awareness of FGM?
Efforts to raise awareness of FGM need to be rolled out in a more strategic, consistent and targeted way as part of a broader violence against women and girls strategic approach. There is a plethora of material available to raise awareness of FGM but it is not clear how effective any of these resources are.
Integrating education on FGM into the school curriculum through PSHE is crucial to ensure that young women and girls are aware of FGM and the law in the UK to empower them to seek help and support if they or their siblings are at risk. However, the Taskforce feels that FGM needs to be addressed through a broader VAWG approach so that girls from affected communities do not feel stigmatised. There are overlaps and connections between all forms of VAWG and schools are ideally placed to both educate children and young people about these issues and to spot the signs of girls at risk or experiencing VAWG.
The Mayor’s VAWG strategy has called for a ‘whole school’ approach to violence against women and girls and this should include FGM. Such an approach would address the needs of pupils, staff and the wider community within a school. It would include FGM and other forms of VAWG being included in school policies such as safeguarding, bullying and social inclusion policies. A ‘whole school’ approach would also include education on FGM and VAWG more broadly for pupils through PSHE and training for teachers and staff on all forms of VAWG including FGM so that they are better able to identify and respond to these issues. For further information please see the Mayor’s VAWG strategy http://www.london.gov.uk/priorities/policing-crime/mission-priorities/violence-against- women-girls
To move away from the current piecemeal approach to education on FGM and VAWG more generally, consideration should be given to creating a mandatory national PSHE curriculum that incorporates FGM and VAWG more broadly.
Community engagement work also needs to be expanded so that there is more consistent coverage rather than pockets of good practice. There needs to be a longer-term strategic approach to community engagement and more consistent funding nationally of specialist voluntary sector organisations that are able to demonstrate expertise in tackling these issues in line with existing quality standards such as the Imkaan harmful practices quality standards.
10. How can the available support and services be improved for women and girls in the UK who have suffered FGM?
199
There is currently very little support available for women and girls in the UK who have suffered FGM. Health consequences include a range of gynecological, reproductive and urinary complications and significant psychological legacies. While our objective is to prevent FGM from happening in the first place, there needs to be a greater focus on providing specialist support services to women and girls that have already suffered FGM.
The ‘Missing Link’ report into harmful practices in London highlighted the need for more specialist BMER women’s services as they are more likely to identify and respond to cases of FGM and other forms of harmful practices. BMER women and girls feel safer in disclosing within these types of services.
The Taskforce would like to signpost you to the ‘Missing Link’ report which provides greater detail on the types of services and support women and girls in the UK who have suffered FGM need. This includes ongoing casework/advocacy support, peer support and confidence-building, refuge provision and resettlement services. Therapeutic support for women and girls who have experienced FGM is a significant gap that needs to be addressed.
Improving access to specialist support services is a key element of our approach to FGM and harmful practices more broadly, as set out in the Mayor’s Violence against Women and Girls strategy and will be a key part of the two pilots we will be launching in London.
Mayor of London’s Harmful Practices Taskforce February 2014
Appendix: Harmful Practices Taskforce membership
MOPAC Metropolitan Police Service Crown Prosecution Service NHS England, London London Safeguarding Children Board Royal College of Midwives Imkaan Children and Families Across Borders Equality Now NSPCC
200 Written evidence submitted by the Association of Chief Police Officers (ACPO) for England, Wales and Northern Ireland
(A) Introductory Remarks
1. The Association of Chief Police Officers (ACPO) for England, Wales and Northern Ireland has prepared this submission to the Home Affairs Select Committee (HASC) on Female Genital Mutilation (FGM). 2. Tackling Violence Against Women & Girls including FGM, Honour based Violence, Child Abuse, Sexual Violence and Domestic Abuse are amongst the key documented priorities for ACPO who work with police forces across England, Wales and Northern Ireland. 3. ACPO is wholly committed to providing a leadership role and working with statutory, non- statutory agencies and affected communities in preventing and tackling Violence Against Women & Girls in all its forms including FGM. It is ACPO’s view that FGM is Child Abuse and is also a fundamental abuse of the victim’s or survivor’s human rights. 4. This submission sets out a response to the six questions posed by HASC, whilst including the background to the ACPO Honour based Violence portfolio, which includes Female Genital Mutilation (FGM).
(B) Honour Based Violence Background 5. The Association of Chief Police Officer’s (ACPO) first Honour Based Violence (HBV) strategy was published in October 2008. ACPO defines Honour based violence as:
A crime or incident, which has or may have been committed to protect or defend the honour of the family and/or the community.
6. This definition, which is accompanied by more detailed explanatory notes, was also adopted by HM Government and the Crown Prosecution Service (CPS). 7. The updated ACPO HBV strategy is in the process of being developed and will be published following consultation with the police service, other statutory agencies, non- government organisations (NGOs) and community representatives. 8. Honour based Violence is an umbrella title, which describes an array of crime and incidents perpetrated in the name of honour and its manifestations including Forced Marriage, child brides, FGM, rape and other sexual offences, kidnap, false imprisonment, forced suicides, acid attacks, missing persons et al. This crime genre sits within much wider Public Protection and Violence Against Women & Girls frameworks. 9. There are 9 ACPO Regional lead police officers who meet regularly with the ACPO HBV lead to discuss and progress the strategy, plans and current issues affecting the wider
201 portfolio or focussed areas. Each of the 43 Police Services in England, Wales and Northern Ireland has a lead police officer for Honour based Violence. 10. Pending the finalisation of its strategy, ACPO has prioritised the follow areas from its current delivery plan:
Development of Problem Profile and Intelligence requirement Communication Strategy Partnerships and Prevention [Community Driven Solutions] Training FGM and Criminal Justice [Justice Seen, Justice Done] Victim and Survivor confidence [Trust & Confidence and Accessibility] Continuous Learning.
(C) How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
Effectiveness of the legislation 11. It is well documented that there have been no direct prosecution of offences under the Prohibition of Female Circumcision Act 1985 and the Female Genital Mutilation Act 2003 (hereafter referred to as the Act). 12. In the examination of legislation and its effectiveness one must also examine the range and quality of evidence to provide a sufficiency of evidence to charge and achieve a realistic prospect of a conviction. With this in mind there cannot be an automatic assumption that the Act etc is in itself ineffective, but better examine the surrounding circumstances and get to the heart of and achieve a better understanding of what is a complex problem. 13. Whilst there have been no prosecutions, the police service, most notably the Metropolitan Police Service has referred 10 investigations to the Crown Prosecution Service for advice, which have highlighted various challenges to evidencing cases under the Act. Cases remain under review by the CPS.
The FGM Act 2003 (the Act), which can be summarised as follows:
Section 1 makes it an offence for a UK or non-UK national to mutilate female genitalia
Section 2 makes it an offence to incite or assist a girl to mutilate herself within the UK.
Section 3 makes it an offence to aid, abet counsel or procure another person who is not a UK national to mutilate a girl’s genitalia outside the UK [Section 3 is only relevant
202 if it is done in relation to a United Kingdom national or permanent United Kingdom resident, and it would, if done by such a person, constitute an offence under section 1].
Non-permanent residents (impact on Jurisdiction)
14. The Act is clear regarding UK based offending but obvious problems arise under Section 3, where a child [who is a temporary resident] in the UK and has undergone FGM abroad an offence is not made out if either the victim and/or or the suspect(s) are not permanent UK residents. The Act specifically excludes those on temporary visas, such as student visas and visitors. 15. The legislation only allows for permanent UK residents to commit the offence of FGM abroad; therefore people who are temporary UK residents remain unaffected by the Act. This provides a loophole for non-UK residents – as defined, to commit FGM offences abroad. That said alternative interventions maybe considered under relevant Child Safeguarding legislation. 16. ACPO is aware that the Metropolitan Police Service is currently investigating a number of cases relating to non-permanent residents. 17. It is ACPO’s view the law should be updated to close the loop-hole associated with the victim’s and suspect’s nationality.
Re-infibulation 18. The current legislation is not absolutely clear on whether re-infibulation constitutes an offence under the current FGM Act. The different types of FGM procedures suggest that re- infibulation beyond the World Health Organisation (WHO) guidelines is an act of FGM. 19. The term Infibulation is used by the WHO to describe a specific procedure that involves cutting. The WHO divides FGM into four categories, the third of which is referred to as infibulations and describes it as: Type III — Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation). 20. The Department of Health has also adopted the WHO definition. However, the British Medical Association describes a different procedure, which includes amputation. 21. The wording of section 1 of the FGM Act 2003 refers only to “excises, infibulates or otherwise mutilates” (and is not defined further). 22. The ACPO view is that re-infibulation could an offence under the FGM Act. In short if it is an offence to infibulate in the first place, it must also be an offence to re-infibulate. This forms the basis of a case, which the police service has asked the Crown Prosecution Service to consider.
203 23. It is ACPO’s further view that this issue would need to be tested in the courts unless legislation is updated to specifically include re-infibulation.
Parental liability 24. Where the parents of a potential victim of FGM have been aware that their child is to undergo the procedure, consideration must be given to their liability. If they have arranged for their child to undergo the procedure then they may commit offences of aiding, abetting, counselling or procuring offences (in this country). 25. The current legislation doesn’t place a positive duty on parents or carers to prevent their child from being mutilated on the instigation of another, such as extended family members. The involvement of extended family members is synonymous with crimes perpetrated in the name of honour. A parent who wilfully or recklessly neglects his/her child or exposes them to ill-treatment is guilty of child cruelty (section 1 Children and Young Persons Act 1933). A parent whose child was mutilated after they had left the child in the care of an extended family member in circumstances whereby the parent was aware of the risk that the child would be subjected to mutilation would potentially be guilty of an offence. The same would be true of a parent who didn’t seek medical attention for a child suffering the after- effects of a FGM act. 26. It is ACPO’s view that consideration should be given to referencing parental liability in updated FGM legislation.
Cosmetic surgery 27. Cosmetic surgery relating to removal of parts of the labia (‘excision’) or any other injection, piercing or other surgical intervention is often undertaken in the UK for cosmetic reasons and is likely to be an offence under section 1 of the Act. 28. Section 1 of the Act provides a defence, if the act is undertaken by a registered medical practitioner and it is ‘a surgical operation… which is necessary for her physical or mental health, or a surgical operation on a girl who is in any stage of labour, or has just given birth, for purposes connected with the labour or birth’ [Section 1 FGM Act 2003, paragraph (2)]. 29. There is a perceived ‘double standard’ whereby there is a focus on practicing Black & Ethnic Minority communities yet within the wider community the private medical market appears to be flourishing. 30. Clear direction, guidance and reality checking of compliance with legislation must take place by the relevant medical governing bodies within the private medical industry. (D) Barriers to achieving a successful Prosecution
Victim and Survivor Trust and Confidence
204 31. As with other forms of honour based violence the investigation of FGM offences is reliant on women, girls, non-government organisations (NGOs) and statutory agencies including health and education reporting their concerns and making referrals (as necessary) to the police and others e.g. NSPCC FGM Helpline, which was launched on 24th June 2013. 32. Fundamentally there is evidence that girls who are old enough to understand their experiences don’t want to criminalise their families and their culture by reporting instances to the police. In addition as described later in this submission there are concerns harboured by affected communities and professionals e.g. health, social care about how the police service will handle and use the information provided to them. This latter aspect is part of the Director of Public Prosecution’s (DPP) FGM action plan and will form part of ACPO’s Communication Strategy. 33. The younger victims and survivors; aged 5 – 15 years don’t realise that criminal offences have been committed against them, as the event has been ‘sold’ to them as a rite of passage to adulthood, womanhood, preservation of integrity & chastity and the girl’s and her family’s acceptance [and honour] within their culture and community. 34. Some of victims and survivors - vulnerable people - fear reporting incidents involving the police and social services in their families and the implications of providing evidence within the Criminal Justice System. 35. Victims are reluctant to report parents/family for fear of prosecution and reprisals against them and other witnesses who include friends and other family members. In investigations police investigators must also be cognisant of the victim’s and their extended family’s origins, experiences and their relationship with the police and statutory agencies in their country of origin e.g. persecution on the basis of culture etc. 36. Affected communities (BME communities) are still under-represented within the police service and do not reflect the communities we serve. Suffice to say substantially more work needs to be undertaken by BME role models within the police service from affected communities to encourage victims / survivors to report their crimes or their concerns about falling victim to such practices or other forms of honour based violence. 37. The social context of FGM can be best described by 1UNICEF: ‘FGM/C [sic Female Genital Mutilation / Cutting] is perceived by practicing communities as a fundamental part of cultural group identity’ and ‘necessary to prepare girls for adulthood, wifehood, womanhood and motherhood. Put simply, FGM/C is a social norm for practicing communities’ (UNFPA and UNICEF Annual Report’ 2012 p ix). 38. The social drivers are complex, and are embedded within deep-rooted traditional practice, which acts are a major barrier to tackling the problem. It is for this reason that ACPO has determined that Community Driven Solutions are fundamental to engender and drive
1 http://www.unfpa.org/webdav/site/global/shared/documents/publications/2013/UNICEF- UNFPA%20Joint%20Programme%20AR_final_v14.pdf
205 sustained change i.e. affected communities must be wiling, confident and able to recognise the need to change and begin the long process of changing attitudes to the practice. In 2013 the MPS received 69 FGM related referrals however less than one third of these referrals came from the family or community. 39. The scale of the challenge of eradicating FGM is further emphasised in UNFPA and UNICEF Annual Report 2012, which states; changing social norms requires the participation of the entire community and social network to come to a consensus to abandon FGM/C collectively, ensuring that no individual family is disadvantaged by the decision. As this process of social change must originate with the communities themselves, a one-size-fits-all model of implementation is inappropriate (UNFPA and UNICEF Annual Report’ 2012 p ix). 40. This scale has been further underlined in a Royal College of Mid-Wives report, which states; ’Increased knowledge and awareness of FGM has not always resulted in abandonment of the practice, as community based surveys have shown that people can be aware of the illegality of FGM and its health impacts, but continue to support the practice’ 41. The above report also states that ‘Community based studies make it clear that although there are younger women who speak out, within the UK many women in affected communities who are under pressure to practice FGM. . 42. It is ACPO’s view that there is a need for a wider ‘whole system approach’ with effective community engagement by statutory agencies – with the support of affected communities and specialist NGOs, and wider public sector information sharing to better enable police forces to investigate FGM offences, associated offending and to Safeguard Children and their siblings.
Further issues relating to investigation 43. Evidentially there are challenges with medical professionals accurately dating when FGM has taken place, problems obtaining reliable evidence from the country where the offence takes place if outside the UK (particularly if it is a country where FGM is not outlawed or where regionally it maybe culturally acceptable). 44. Obtaining medical evidence specifically where a victim / survivor has not engaged with and declines to be part of any criminal investigation and does not give their consent to further medical examination. This is likely to be an issue when type IV FGM is suspected and further medical examinations maybe necessary. 45. ACPO is working closely with the CPS and attends the DPP’s round-table working group on the subject. ACPO is also playing a key role in ensuring that the Police & CPS Service Level Agreement (regarding investigations and prosecutions) is being rolled out across
206 England & Wales and is complemented by the joint Police Investigator & CPS Prosecutor FGM training sessions, which commenced on 10th February 2014. 46. The College of Policing has launched a Public Protection package, which incorporates FGM, for Police Officers of all levels.
Agency referrals 47. There remains a lack of referrals directly from communities at present, however with the developing success of the NSPCC FGM helpline it is anticipated that the number of referrals will continue. 48. The NSPCC - FGM hotline (launched on the 24th June 2013) has had 112 contacts, which resulted in 35 referrals to a number of Police Forces as of the 15th October 2013. This data is currently being refreshed. 49. That said the lack of referrals from affected communities places an emphasis on the importance of referrals from statutory agencies such as health, education and social care. 50. Using data supplied by the MPS there were 161 cases referred to them from 2010 – 2013, of which Education made 34 referrals, Health made 17 referrals and Social Care made 57 referrals. There was one referral from the specialist third sector and 6 from the NSPCC. 51. In Derbyshire there were 3 referrals during the last 12 months from maternity services. None of these referrals generated a prosecution, but generated safeguarding discussions with Children’s Social Care. 52. Between 1st April 20111 and 31.8.13 West Midland Police record 63 incidents of FGM of which 7 were recorded in the 9 months of 2011, 24 in the full year 2012 and 32 in the first 8 months of 2013. Referrals were made from Health Care professionals (£% cases), Social Care (11) and Education (6). 53. Of course health and education agencies may have referred cases to social care, which should happen unless a girl was at immediate risk of significant harm, when the case should be referred to the police service too. Any cases, which do not meet the referral or disclosure threshold to the police service will be retained within social care whereby a section 47 Children’s Act investigation maybe undertaken. 54. The London Safeguarding Children’s Board (LSCB) guidance for example states that ‘A girl who has already undergone FGM should not normally be subject to a child protection conference or registered unless additional child protection concerns exist. However, she should be offered counseling and medical help. Consideration must be given to any other female siblings at risk ….’ Such cases will therefore not be likely to be referred to the MPS, which denies the police service an opportunity to investigate a serious crime, a serious crime of child abuse. 55. As stipulated previously other statutory agencies, affected communities and NGOs (or third sector agencies) still appear reluctant to share information and report cases to the police
207 because they do not know the police service will handle or otherwise act upon their information. This must change with engendering of trust and confidence amongst professionals and others, most notably that the police will handle the information sensitively and will not overact in a risk averse way upon its receipt. 56. Health professionals are particularly concerned about the trust developed with women and girls who seek their help and are genuinely concerned that sharing of information will put off women and girls from seeking help in the future leading to medical complications. 57. That said again using MPS data referrals to them have increased to 69 in 2013, which appears indicative of improved information sharing and trust in how the MPS will manage the referral. 58. Information sharing must improve if we are to better understand prevalence rates in order that the wider partnership can more effectively target its education of communities and professionals and other specialist resources. ACPO welcomes the HM Government and MPS jointly funded prevalence study being undertaken by Equality Now and City University. 59. ACPO concurs with the Royal College of Mid-Wives when it calls for ‘A whole systems approach’ - to ensure information is referred appropriately across the agencies, which in the longer term will improve trust and confidence across the partnerships tackling FGM and may lead to improved enforcement outcomes. 60. ACPO recommends that the there must be mandatory referrals (not determined by legislation leading to criminal sanctions for professionals not referring) from the Health Care Industry (Private and NHS) to Local Authorities and Information sharing on all FGM victims from Social Care to the Police in order that a joint professionals’ decision can be made in the best interests of the child and others. 61. To illustrate this point of the 69 FGM referrals made to the MPS in 2013 only 20 were recorded as an FGM offence with a 56 cases investigated or whereby safeguarding action was taken. The remaining 13 referrals did not amount to a requirement for police action.
Police Operational Activity (Past and planned) The following represents a glimpse of the past and future police operational work:
June 2013 National Leads meeting in London. Each Region/Force tasked with undertaking local operations to counter High Risk seasonal FGM - Summer Holidays Two Operation Limelight - Heathrow Airport: airside operation targeting 2 flights from Sierra Leone leading to 2 separate arrests. Girls examined and eliminated as victims. Two covert operation conducted by MPS after intelligence was received about so-called ‘cutters’. Further covert operations will be undertaken in England & Wales. There is an unequivocal public commitment to do this.
208 Eight forces will be taking part in coordinated airside airport operations. West Midlands Police have used posters, Neighbourhood officers at community centres to build confidence, raise awareness and sought community intelligence Forces are participating in Awareness Raising events on 6th February 2014 i.e. International Day of Zero To FGM Police led FGM Conference in London 29th March 2014 - to be attended by Health, education, voluntary services, community and religious leaders and members from the community.
(E) Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
Global Picture 62. The World Health Organisation (WHO) estimates that 100-140 million girls and woman affected by FGM worldwide, which includes circa 3 million girls under the age of 15 years. 63. FGM practised in 42 countries throughout the world wide and according to UNICEF’s (2013) statistical survey, FGM was conducted on girls under 5 years in half of the countries surveyed. In the rest of the countries it was practiced between the ages of 5 to 14 years. That said there have also been reported instances where FGM was undertaken later in a woman’s life. For example there is evidence of a case of a Nigerian woman in her 40s – who now lives in the UK - having undergone FGM following her marriage in Nigeria.
UK Picture and Understanding 64. Although the public profile of FGM has increased over recent years, what is and remains less developed is our understanding of the problem profile. 65. An estimate of 66,000 women and girls having experienced FGM has been quoted in many publications and discussion on the subject and interpreted as an accurate representation of the UK’s problem profile. ACPO urges caution in the use of this figure and encourages clarity of understanding of this figure. 66. The 66,000 figure is extrapolated from the 2001 census data, which is based upon prevalence rates in countries worldwide and then applied to those communities resident within the UK. 67. This analysis has led to an estimate of 66,000 women and girls who are living with the consequences of FGM in the UK. Whilst this is an important starting point to help understand the spread and density of FGM across different communities within the UK it is no longer current. Further studies reveal that some 23,000 girls under 15 years old at risk of FGM.
209 68. The main prevalence areas in the UK are London, Manchester, Birmingham, Sheffield, Cardiff, Northampton, Oxford, Crawley, Reading, Slough and Milton Keynes 69. The Home Office and the Metropolitan Police Service (MPS) are part funding a new study into FGM prevalence rates in England and Wales. The study, which will provide the most up-to-date data on the UK’s FGM prevalence rates based on the 2011 census data is being carried out by Equality Now and City University. The results of this study are due to be published in circa March 2014. 70. It is critical to distinguish between what such information tells us and not to misunderstand or misrepresent it. It does attempt to depict ‘occurrence’ rates of FGM within the UK. That said current occurrence rates are an unknown factor, which has an unequivocal impact on referrals to police, police investigations the subsequent referral to the CPS for prosecution advice and decisions. 71. That said it is ACPO’s assessment based on sensitively gathered information together with the first hand experiences of front line workers that FGM is not being practiced to the extent within the UK as being reported.
Identified Risk Indicators Mothers, female siblings or members of extended family are who victims of FGM Long summer holiday - girl may be taken out to her country of origin or another country where practise is prevalent. Girl may confide that she is to have a ‘special procedure’ or is attending a special occasion to ‘become a woman’ Change in behaviour - withdrawn, difficulty in walking, sitting, spending longer in the toilets etc Older women visit the UK More prevalent and likely to occur in communities less integrated into the UK (harder to reach).
(F) What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved? 72. The response to this question has been threaded throughout this submission. It is nevertheless evident that all agencies have a key role to play in tackling FGM whether it is Prevention, Protection, Prosecution of FGM cases through Partnership arrangements. 73. The respective roles of the agencies are documented in 2HM Government’s FGM Multi- Agency Practice Guidelines, although there is an omission relating to the key role of the Education Authorities.
2 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216669/dh_124588.pdf
210 74. It is ACPO’s view that FGM Multi-Agency guidelines should be updated to reflect the key role of Education Authorities and establishments and that the Guidelines should be placed on a statutory footing in the same way as 3HM Government’s Multi-Agency Practice Guidelines for handling cases of Forced Marriage [Section 63Q Forced Marriage (Civil Protection) Act 2007 refers]. 75. The flagging of FGM cases across statutory agencies is essential to better identify and track cases, which is of particular note in health, social care, education and the police service, which is reflected in the recently published 4 The Royal College of Midwives, Tackling FGM in the UK, Intercollegiate report. ACPO is currently addressing the flagging of FGM cases with police forces in England, Wales and Northern Ireland. 76. The public services must become less reliant on personality driven activity and ensure that FGM is tackled and led within their organisations in a systemic and accountable way. 77. In addition there remains a requirement for the sustained training of front line professionals to understand & recognise the warning signs of honour based violence and FGM, whilst also providing the competence and capability to interpret, identify, assess and manage risk. 78. Furthermore detailed engagement work is also required to improve the trust and confidence of affected communities, NGOs and other professionals as referenced elsewhere in this report. It will be beneficial to have funding to provide a sustained outreach programme in those areas of the UK identified following the recently commissioned prevalence study.
79. In addition further engagement and education work needs to be undertaken with UKBF, BAA, HMRC, Airlines (as undertaken by the MPS), Travel Agents and Train Operators to identify and recognise victims in distress and understand that as a uniformed service they maybe approached by victims for help. For some potential victims such services maybe the last chance of help and survival.
80. There are many good examples throughout the UK of excellent partnership work taking place on a local and regional basis including in London, Bristol, West Midlands and Derbyshire to name but a few.
(G) How can the systems for collecting and sharing information on FGM be improved? 81. As previously stipulated the flagging of FGM cases across statutory agencies is essential to better identify and track cases, which is of particular note in health, social care, education
3 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/35530/forced-marriage- guidelines09.pdf 4 (2013) The Royal College of Midwives, Tackling FGM in the UK: Intercollegiate recommendations for identifying, recording and reporting http://www.rcog.org.uk/files/rcog- corp/FGM_Report%20v10%20a~final%20forwebsite.pdf
211 and the police service, which is reflected in the recently published 5 The Royal College of Midwives, Tackling FGM in the UK, Intercollegiate report. ACPO is currently addressing the flagging of FGM cases with police forces in England, Wales and Northern Ireland. 82. That said in order to support the flagging and tracking of cases there is a need to identify and record cases. In order to achieve this ACPO supports the mandatory recording and reporting of FGM cases by health professionals, which is mandated through strategic guidance processes (rather than statute), which Chief Executive Officers are accountable for delivering and which are reality checked through audit processes. The same can be said for the police service.
(H) How effective are existing efforts to raise awareness of FGM? 83. There are a number of initiatives supported by the police service across the UK to raise awareness including the MPS’s Summer Campaign (started in Summer 2006), Police / CPS joint training initiative, Derbyshire police awareness raising in schools, Conferences planned in London (March 29th), Derbyshire (June 2014) and Birmingham (24 February 2014). In addition West Midlands Police has also launched an external anonymous survey via social media, which was preceded by the ‘Don’t have blood on your hands’ campaign. 84. However it is essential that there is a unified communication strategy at a national level to provide consistent key messages to victims and prospective victims, affected communities and professionals to provide trust and confidence and to sign post victims & survivors to the correct support and advice. 85. Whilst the International Day of Zero Tolerance to FGM is important, there must be a sustained and consistent effort across the widest range of partnerships throughout the year.
(I) How can the available support and services be improved for women and girls in the UK who have suffered FGM?
86. The answer to this question can be found threaded throughout this submission and the recommendations made. 87. Key to this question is the outcome of the updated Prevalence Study, which is due to report back in March 2014. This study will allow more informed decisions to be made about targeting the right resources in the right places in a concentrated and consistent way.
Association of Chief Police Officers (ACPO) for England, Wales and Northern Ireland February 2014
5 (2013) The Royal College of Midwives, Tackling FGM in the UK: Intercollegiate recommendations for identifying, recording and reporting http://www.rcog.org.uk/files/rcog-corp/FGM_Report%20v10%20a~final%20forwebsite.pdf
212 Written evidence submitted by Foundation for Women’s Health Research and Development (FORWARD UK)
Contents Declaration of Interest ...... 2 Background ...... 2 The Context of FGM in the UK ...... 3 The effectiveness of the existing UK legislative framework on FGM and the barriers to achieving a successful prosecution in the UK ...... 4 Recommendations ...... 6 Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention? ...... 6 Exploring the respective roles of the police, health, education and social care professionals, and the third sector: how can multi-agency co-operation be improved? ...... 7 How can the systems for collecting and sharing information on FGM be improved? ...... 9 How effective are existing efforts to raise awareness of FGM? ...... 10 How can the available support and services be improved for women and girls in the UK who have suffered FGM? ...... 11 Conclusion: ...... 12 Recommendations: ...... 12
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Declaration of Interest 1. FORWARD is an African Diaspora women led campaign and support organisation with a vision that African women and girls live in dignity, are healthy, have choices and equal opportunities. Our goals include preventing gender based violence, in particular female genital mutilation (FGM) child marriages and related health complications and human rights violations; improving access to sexual and reproductive health services; skills and livelihood options; strengthening knowledge base and capacity of project partners and enhancing voice and leadership of Diaspora African women in the UK.
2. FORWARD is responding to this Select Committee inquiry as the lead agency working on FGM in the UK. We promote a comprehensive approach to tackling FGM, working nationally and abroad to ensure dignity and rights of African women and girls. We provide public education and training to shift understanding of this practice. We generate evidence, information and resources to influence and shape policy and professional responses to FGM. We facilitate leadership development, empowerment and build confidence of women and girls, communities and young people support at local level to bring about attitudinal and behaviour change. As a legacy organisation we have supported programmes within the UK and Africa and nurtured a number of activists in the field including founders of Daughters of Eve, Orchid Project and 28 Too Many.
Background 3. FGM is a human rights violation which has been on the UK policy agenda for the past two decades. The UK government has submitted several reports to human rights treaty bodies in particular CEDAW detailing its efforts to respond to discrimination against women and specific actions in relation to FGM. 4. The UK has sponsored the UN General Assembly Resolution on Intensifying efforts for the elimination of FGM which emphasise “the need to develop, support and implement comprehensive and integrated strategies for the prevention” of FGM (para 15).
5. The UK is signatory to the Council of Europe Convention on preventing and combating violence against women and domestic violence. The Istanbul Convention requires States to prevent, prosecute and eliminate physical, psychological; and sexual violence, including FGM. To implement these obligations, States Parties are required to adopt state-wide effective, comprehensive and co-ordinated policies that would comprise all relevant measures to prevent and combat FGM and all other forms of violence against women, and that would form part of a holistic response to violence against women. a. The Convention also foresees an obligation for States parties to legislate to recognize FGM as a criminal offence, including the act of coercing or
214 procuring a woman or girl to undergo the procedure “voluntarily” (Article 38). According to the Convention FGM should be punishable by effective, proportionate and dissuasive sanctions (Article 45). However, the Convention insists on the fact that consideration should be given first and foremost to the child’s best interest in accordance with the UN Convention on Rights of the Child. Prison sentences, large fines or long separations from the parents/family may have a serious impact on the child’s well-being and must therefore be weighed against other options. b. In its thematic paper on Legislative reform to support the abandonment of Female Genital Mutilation/Cutting (August 2010), UNICEF recalls that the Convention on the Rights of the Child (in Article 9.1) “provides that unless necessary for the best interest of the child and determined by competent authorities according to the law, a child should not be separated from his or her parents. Only when the girl appears to be at high risk, and if the parent after multiple warnings is assessed as not responding to other interventions, should long-term alternative care options be considered.” Efforts should be made to change the underlying beliefs that perpetuate FGM.
6. In 2000, the UK organised the first Parliamentary Hearing on FGM, by the All Party Parliamentary Group on Population, Development and Reproductive Health which brought together lead organisations working in the field, local authorities, medical professionals as well as UN agencies and WHO experts with the aim to produce recommendations for future strategies on FGM for the UK. 35 key recommendations were made focusing on legislative changes; education policy; sustainable funding for community based work and health strategy. The majority of these recommended actions were never translated into policy action.
The Context of FGM in the UK 7. According to the latest UNICEF report on Female Genital Mutilation (2013), FGM continues in 29 countries in Africa, as well as some in the Middle East.
8. In the UK, data from a study conducted by FORWARD1 indicated that up to 100,000 women and girls are affected by all types of FGM. 9. A new study soon to be released by FORWARD will show that many girls are now subjected to FGM between 5 and 8 years – thus reinforcing the need for youth friendly and appropriate services and support provisions. 10. The political landscape of FGM has also altered significantly in the past three years. The introduction of the Home Office led Violence against Women Action Plan, included mentions of FGM. In addition, the release of the Crown Prosecution Service’s guidance and action plan on FGM, a Westminster Hall debate led by Karl Turner, (Labour MP for Kingston Upon Hull East), and the presence of leading political ambassadors against FGM, such as the previous Female Genital Mutilation
1 A statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales (2007)
215 APPG Chair, and current Public Health Minister Jane Ellison have led to increased attention and focus on FGM. Significantly, the Department for International Development (DFID) also announced a £35 million fund for FGM related work. The Home office also introduced a £50,000 for community engagement. In addition, since the latter half of 2013 there has been a considerable increase in the media attention devoted to FGM. Media campaigns by the Evening Standard and The Times have highlighted existing gaps in provision of services for women affected by FGM, the lack of sufficient data related to FGM, and that there have been no FGM related prosecutions since the passing of FGM related legislation in 1985. 11. The Guardian has also launched an FGM campaign calling for the Education Secretary, Michael Gove and the Department for Education (DfE) to play its part in the effort to protect girls from FGM. The effectiveness of the existing UK legislative framework on FGM and the barriers to achieving a successful prosecution in the UK
12. The current legislative framework on the FGM should be reviewed and where necessary strengthened. The Female Genital Mutilation Act whilst a progressive revision on the former legislation (Female Circumcision Act 1985), still includes loopholes, which need to be closed.
13. Language: The language used to define FGM in the Female Genital Mutilation Act is not in line with the World Health Organisation (WHO) definition and needs to be clarified. The WHO defines the procedure as
a. “[comprising] all procedures that involve [the] partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.”2
14. This definition can be used to encompass FGM Type I to Type IV. If the Female Genital Mutilation Act was amended to include this definition, there would be no room for contestation for any act of mutilation on the genitalia of girls and women, and would thus further ensure the legislative protection of girls and women.
15. Extraterritoriality: Currently, the Female Genital Mutilation Act states an offense has been committed if either a UK national or permanent resident is taken abroad and an act of FGM is committed against them. However, this provision fails to include residents who are in the UK on temporary visa (such as those on work and student related visas). The act fails to explicitly state that all residents commit an offense should they choose to take a girl, or aid a girl to be taken abroad for an act of FGM to be committed against them means that some girls in the UK are not sufficiently protected by the current legislation. The UK is a signatory of the Council of Europe Convention on preventing and combating violence against women and domestic violence (Istanbul Convention). Article 38 of the convention states that:
2 Female Genital Mutilation Factsheet No 241, WHO, updates February 2013
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a. Parties shall take the necessary legislative or other measures to ensure that the following intentional conducts are criminalised:
b. excising, infibulating or performing any other mutilation to the whole or any part of a woman’s labia majora, labia minora or clitoris; c. coercing or procuring a woman to undergo any of the acts listed in point a; d. inciting, coercing or procuring a girl to undergo any of the acts listed in point a. 3
16. Recommendation: Article 38 of the Istanbul Convention comprehensively captures all women affected by FGM irrespective of residency. We recommend that the Female Genital Mutilation Act is amended to be in line with the Istanbul convention.
17. Child protection: FGM is a child protection matter, and should be considered within and fully integrated into the current child protection legislative framework. Where relevant, other legislation related to child protection should be used in FGM related cases to enable the safeguarding and protection for survivors.
18. Female Genital Cosmetic Surgery (Labiaplasty): Female Genital Cosmetic Surgery (FGCS) is increasingly popular in the UK. FGCS procedures such as labiaplasty are worryingly similar to Type I and II FGM, and may result in similar health complications such as reduced sensation, infection and bleeding, and wound dehiscence.4 Whilst currently legal, the practice is mainly performed in the private sector and subject to little regulation. As a result, there is very little activity and outcome data, and the numbers of procedures that have taken place in the private sector are unknown.5
19. However, in the past ten years, there has been a fivefold increase in the number of labiaplasty procedures – the most commonly performed type of FGCS - taking place on the NHS.6 And between 2008 and 2012, 266 labiaplasty procedures were performed on girls under the age of 14 in the NHS.7 Thus we can legitimately posit that the number of FGCS procedures is going up.
3 Article 38, Council of Europe Convention on preventing and combating violence against women and domestic violence, http://www.coe.int/t/dghl/standardsetting/convention- violence/convention/Convention%20210%20English.pdf
4 Labia Reduction Surgery on Adolescents, British Society for Paediatric and Adolescent Gynaecology, pg. 4, October 2013 5 ibid 6 Ibid. 7 ibid
217 20. A joint position paper by the Royal College of Obstetrics and Gynaecology (RCOG) and the British Society for Paediatric and Adolescent Gynaecology (BritSPAG) stated that:
a. “There is no recognisable disease process warranting surgical treatment and no creditable evidence to demonstrate lasting effectiveness along physical, psychological and sexual parameters.”
21. The position paper also made a strong recommendation that the procedure should not be carried out on girls under the age of 18. The medical position as expressed by the RCOG and BritSPAG, as well as increasing evidence to suggest that the procedure may result in similar impacts to FGM, lead us to suggest that the legislative framework regarding FGCS must also be clarified and strengthened. Reference to FGCS should also be made in the Female Genital Mutilation Act. Without it we may be subject to the risk of FGM procedures may take place under the guise of being conducted in a medical environment.
Recommendations
22. We recommend that the third provision of the Female Genital Mutilation Act 2003 is amended and explicitly states that the removal of a girl for FGM to be acted upon her internationally is illegal.
23. We also recommend that the CPS explore other child protection legislation – such as the Children’s Act - to ensure that girls affected by FGM receive full protection and justice through the law.
24. We recommend that the law and regulatory requirements around FGCS are strengthened. We also recommend that FGCS procedures should not be practiced on girls under the age of 18.
Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
25. FGM is a global problem and affects women and girls living in the UK from FGM affected countries in Africa, Middle East and Asia. Those at risk are not a homogeneous group and include British citizens born in the UK, migrant groups, asylum seekers, refugees and students and from affected communities.
26. As identified in a FORWARD study on FGM8 up to 100,000 women and girls in the UK are at risk of FGM. However, this figure is based on a limited number of African
8 (2003)
218 communities, and does not represent those at risk from Middle East and Asia communities - including the Dawda Borah communities, and segments of the Kurdish communities who are known to practice FGM. We therefore suspect that the number of women at risk of and affected by FGM is higher.
27. In addition to acknowledging that women and girls from the 28 African FGM affected countries are at risk,9 FGM must also be considered a form of violence that may affect any girl in the UK. Intermarriage between different ethnicities and cultures broadens the scope of girls at risk. In addition, the mutilation of the female genitalia is a form of abuse and violence – and it may be inflicted on any girl or women for a range of complex reasons.
Exploring the respective roles of the police, health, education and social care professionals, and the third sector: how can multi-agency co-operation be improved?
28. One of the primary duties and roles of the police, health, education and social care professionals is safeguarding. These duties are clearly and comprehensively outlined in the Multi Agency Guidelines: Female Genital Mutilation published by the UK Government. However, these guidelines are currently not statutory and have not been rolled out nationally.
29. In addition, the Children’s Act (2004) clearly outlines that local governments should act as a coordinating body to promote multi-agency co-operation between all officials relevant to improving and enabling the wellbeing and safeguarding of children.10
30. There are examples of successful FGM related multiagency cooperation throughout England and Wales that other local authorities can model themselves on. FGM Forums exist in London boroughs such as Islington, Lambeth, Acton and Hackney as well as in cities such as Bristol, Birmingham and Manchester. These forums differ in their representations but generally include safeguarding professionals, teachers and schools professionals, local authority bodies; medical professionals and the police.
31. The action and information sharing practices that exist in such forums are important to ensure that a robust safeguarding system based on prevention, protection, provision of services and support is available for women and girls at risk and affected by FGM. It is also important that there are procedures to enable coordination among these structures, so where necessary, effective sharing and learning of best practice is possible.
9 Female Genital Mutilation/ Cutting, : A statistical overview and exploration of the dynamics of change, UNICEF, 2013 10 Children’s Act, Section 2 part 10, 2004
219
32. Training:
33. In addition to the coordinating role that local authorities are responsible for, training and community engagement are also key components to enabling a robust response to FGM. Sufficient training for health and safeguarding professionals is also an obligation as stated in Article 15 of the Istanbul Convention, and Article 25 of the EU Directive on the Rights of Victims of Crime.
34. FORWARD, which is an accredited training centre, has trained over 1,500 professionals from statutory and voluntary organisations in the past year. Many of those who attended the training stated a considerably improved level of preparedness to respond to FGM cases should they arise.
35. Training is also important to help increase some statutory professionals awareness and understanding of FGM. For instance, the recent NSPCC survey for teaching staff about FGM11 found that 80 per cent of those surveyed said that they were unaware of FGM.
36. We know that high quality training helps professionals understand the necessary reporting procedures for FGM related cases, help people understand that FGM is deep-rooted cultural practice, and helps them identify signs that may prevent a girl from undergoing FGM.
37. We recommend that FGM is streamlined into the statutory safeguarding training, and that all relevant professionals receive standardised training, preferably from an accredited training centre to help better prevent FGM, and protect and support girls and women who may be affected by FGM.
38. Community engagement: Communities must not be bypassed when we consider and create safeguarding frameworks for girls at risk of and affected by FGM. Communities lie at the heart of the continuance of FGM in the UK and beyond. It is therefore important that communities are aware of the reasons why the continued practice of FGM is harmful and a form of violence and physical abuse. A push for prosecutions, without effective community engagement and education programmes will not result in a sustained end to FGM.
39. Communities also play a crucial role in providing ‘legitimate’ advocates for an end to FGM. Community ambassadors and change agents can play an effective role in communicating messages about the dangers and harms of FGM in a way that doesn’t garner suspicion or fear of authorities.
11 Teachers’ effort to tackle female genital mutilation hampered, NSPCC, March 2013, https://www.nspcc.org.uk/news-and-views/media-centre/press-releases/2013/female-genital- mutilation/NSPCC-warning-teachers-on-FGM_wdn94822.html
220
40. Women from FGM affected communities also provide poignant anecdotal evidence about the efficacy of current FGM related services. A recent focus group conducted by FORWARD, identified that many women still do not feel comfortable discussing FGM with their GPs, and many reported near fatal experiences whilst delivering children. This evidence continues to help us design support and health services that are directly tailored and responsive to the needs of women and girls affected by FGM.
41. FORWARD has also garnered qualitative and anecdotal data, which indicates a trend away from, type III FGM (infibulation) towards what many are describing as Sunna (this may vary from Type I FGM to a level of infibulation). This illustrates that engaging religious leaders is a prerequisite in the effort to end FGM.
42. We recommend that:
43. We recommend that support services for women and girls are available throughout the UK, and that they are widely publicised. 44. We recommend that in addition to services addressing the physical implications of FGM, services to support the mental and psychological needs of women and girls affected by FGM are made available. 45. We recommend that commissioning tenders are drafted in consultation with organisations and experts that understand the specificities of FGM – and therefore reflect the needs of women and girls at risk, and survivors of FGM. 46. We also recommend that public communications work is conducted to help broaden the understanding of FGM as a harmful cultural practice – and not a disease. 47. We recommend that all the above measures are contained within, and monitored as part of a National Action Plan on FGM; community engagement is recognised and as key component of a robust plan to FGM. Sustainable funding and guidelines should be produced on community engagement. How can the systems for collecting and sharing information on FGM be improved? 48. The collection of data related to prevalence and reporting is an important aspect of an effective and systematic response to FGM. Currently, the UK lacks reliable up-to date data related to the number of women and girls affected by FGM in the UK. The most recent FGM prevalence data was compiled by FORWARD in 2007.12 It is encouraging that the Department of Health is undertaking a similar study to get a clearer indication of FGM prevalence in the UK. However, the collection of data must take place in a far more systematic way in order for us to continuously have an idea of the number of women affected by FGM in the UK.
12 FORWARD study on FGM prevalence in the UK (get exact title)
221
49. We also think it is important that clarity is created around reporting procedures related to FGM. The information shared and scaled up to the police must clearly reflect the best interests of the child, and be careful not to result in the immediate criminalisation of women survivors of FGM.
50. We recommend that:
51. The number of women who present at maternity wards and for gynaecological services, and have undergone FGM is collated.
52. A clear pathway for reporting FGM related cases is established and understood by relevant safeguarding professionals.
53. Data collection – along with all other components of a systematic approach to FGM – should form part of a National Action Plan on FGM. This action plan should be Government led, and spearheaded by the Home Office. It should have clearly defined ministerial responsibility, be well resourced and include a framework for monitoring, evaluation and information sharing. The UK can look to other European countries such as Norway, Portugal and Finland as examples of how national action plans can help successfully tackle FGM. The European Communication on FGM, which was released in November 2013, also includes a number of recommendations that can help strengthen the UK’s response to FGM.
54. The UK Government review the recommendations made in the All Party Parliamentary Group on Population, Development and Reproductive Health’s Hearings Report on Female Genital Mutilation (200). Where relevant, we recommend the Government implements these recommendations as part of a UK wide National Action Plan on FGM. How effective are existing efforts to raise awareness of FGM? 55. Work by Third Sector and community organisations to raise awareness of FGM has achieved considerable success. The UK media has also played a significant role in increasing FGM related awareness amongst the British public. However it is important that targeted awareness raising activities are scaled up. This includes communications activities with community media – including broadcast, print and, where necessary training.
56. In addition, the current Government, and interested parliamentarians have played a part in significantly increasing FGM awareness. Communities must be educated and informed about the legal framework around FGM. This work needs resourcing. In previous years, The Home Office allocated a total fund of £50000 for community engagement – this must be increased in order to secure wide reaching engagement.
222 How can the available support and services be improved for women and girls in the UK who have suffered FGM?
57. FGM support systems must, at the core, be survivor-centric. This means that support systems – including well women’s clinics must be designed following consultation with women affected by FGM. These services should be well resourced, advertised and sustainable. FGM supported services should also be tailored to cater to different age groups. It is important that in addition to services for women, youth friendly services are made available and widely publicised. Young people may not in fact be able to, or feel comfortable to discuss their support needs with their parents. Provisions should therefore be made for girls to access these services. This may include equipping school nurses with the appropriate training to signpost girls affected by FGM to the appropriate services.
58. In addition, when FGM contracts are being commissioned, it is important that local authorities speak with groups and organisations working to combat FGM ahead of designing their contracts. The work and targets involved in this work must be based on an understanding of the nuances and complexities involved in responding to FGM – and be about positively impacting survivors and women and girls affected by FGM.
59. We must also be committed to pursuing a “do no harm” approach when responding to women and girls affected by FGM. Those affected must not be subject to lines of inquiry, suspicion or blame that we do not place on those who have been affected by other forms of violence and physical abuse. This is particularly important in social work and criminal cases. We must carefully assess the impact that asking a child to “testify” against their parents may on their wellbeing – including the possibility of isolating minors from their wider communities.
60. In addition, the language used to describe FGM should be both culturally sensitive and survivor centric. The use of terms such as “barbaric” or “backward” to describe FGM, as well as referring to the “eradication of FGM” are not helpful- and can also serve to be antagonistic or alienating.13 FGM is a harmful cultural practice. It is not a disease. We should therefore approach FGM in the same way we approach other harmful practices and social norms.
61. We recommend that: 62. Support services for women and girls are available throughout the UK, and that they are widely publicised.
223 63. In addition to services addressing the physical implications of FGM, services to support the mental and psychological needs of women and girls affected by FGM are made available. 64. Commissioning tenders are drafted in consultation with organisations and experts that understand the specificities of FGM – and therefore reflect the needs of women and girls at risk, and survivors of FGM. 65. Targeted and strategic public communications work is conducted to help broaden the understanding of FGM as a harmful cultural practice – and not a disease. 66. All the above measures are contained within, and monitored as part of a National Action Plan on FGM.
Conclusion: 67. FGM is a complex and long practised harmful cultural practice. The understanding of FGM and exploration of ways to combat FGM is something that has to be undertaken by activists, statutory professionals and government alike.
68. The UK has made some considerable gains to combat FGM; however it is important that these actions go further. In order to do this, the Government must implement a national, sustainable and coordinated response to FGM – this should be done through the creation of a National Action Plan on FGM.
69. Finally, survivors of FGM and those otherwise affected by FGM must be at the centre of all efforts to end FGM. It is therefore important that all activities and work to end FGM is done in consultation with these women and girls.
Recommendations:
70. The third provision of the Female Genital Mutilation Act is amended and explicitly states that the removal of any girl for FGM to be acted upon her internationally is illegal.
71. The CPS should explore opportunities where other child protection legislation – such as the Children’s Act - to ensure that girls affected by FGM receive full protection and justice through existing legal frameworks.
72. The law and regulatory requirements around FGCS are strengthened. We also recommend that FGCS procedures should not be practiced on girls under the age of 18.
73. The Government’s Multi agency guidelines on FGM are made statutory.
224 74. all statutory and safeguarding professionals receive training related to FGM
75. Community engagement is recognised and as key component of a robust plan to address FGM. Sustainable funding and guidelines should be produced on community engagement.
76. The number of women who present at maternity wards and for gynaecological services, and have undergone FGM is collated.
77. A clear pathway for reporting FGM related cases is established and understood by relevant safeguarding professionals.
78. Data collection – along with all other components of a systematic approach to FGM – should form part of a National Action Plan on FGM. This action plan should be Government led, and spearheaded by the Home Office. It should have clearly defined ministerial responsibility, be well resourced and include a framework for monitoring, evaluation and information sharing. The UK can look to other European countries such as Norway, Portugal and Finland as examples of how national action plans can help successfully tackle FGM. The European Communication on FGM, which was released in November 2013, also includes a number of recommendations that can help strengthen the UK’s response to FGM.
79. The UK Government review the recommendations made in the All Party Parliamentary Group on Population, Development and Reproductive Health’s Hearings Report on Female Genital Mutilation (200). Where relevant, we recommend the Government implements these recommendations as part of a UK wide National Action Plan on FGM.
We recommend that support services for women and girls are available throughout the UK, and that they are widely publicised.
80. In addition to services addressing the physical implications of FGM, services to support the mental and psychological needs of women and girls affected by FGM are made available.
81. Commissioning tenders are drafted in consultation with organisations and experts that understand the specificities of FGM – and therefore reflect the needs of women and girls at risk, and survivors of FGM. a.
82. That public communications work is conducted to help broaden the understanding of FGM as a harmful cultural practice – and not a disease.
225 83. All the above measures are contained within, and monitored as part of a National Action Plan on FGM.
226 Written evidence submitted by the Equality and Human Rights Commission
About the Equality and Human Rights Commission 1. The Equality and Human Rights Commission is an independent statutory body established under the Equality Act 2006. The Commission works to reduce inequality, eliminate discrimination, strengthen good relations, and promote and protect human rights. We do this by helping to ensure that everyone is protected against unfair treatment and has fair opportunities; by promoting and safeguarding the human rights we all enjoy; and by encouraging mutual respect between people of all backgrounds.
2. We use our powers to support and promote laws and practices that help make our society fair for everyone. We use our strategic enforcement powers to ensure the law is working as intended, holding organisations to account for meeting equality and human rights standards. 3. The Commission has achieved ‘A’ status accreditation as a National Human Rights Institution, enabling us to participate in the United Nations Human Rights Council, and to undertake monitoring of the UK’s human rights obligations.
4. We also give advice and guidance to businesses, the voluntary and public sectors, and to individuals.
Summary 5. Female Genital Mutilation (FGM) is a form of child abuse and violence against women and girls, and amounts to torture. The practice violates human rights, and agencies or professionals charged with protecting children should not allow misplaced cultural sensitivity to deter them from tackling it robustly. In order to fulfil its obligations to protect potential victims and support those who have been subjected to FGM, the UK Governments should implement a comprehensive, coordinated and properly funded strategy, and hold relevant organisations to account for delivering high standards in protecting women and girls. The Commission would be well placed to monitor the delivery of such a strategy.
Background
227 6. FGM is a criminal practice of mutilation of the female genital organs for non-medical reasons, which has severe consequences for women’s health. It is usually carried out on girls between infancy and age 15, with the majority of cases occurring between the ages of five and eight years. The procedure is traditionally carried out by a female with no medical training, without anaesthetics or antiseptic treatments, using knives, scissors, scalpels, pieces of glass or razor blades. The girl is sometimes forcibly restrained
7. While FGM may be viewed as a form of cultural expression among its supporters, and may be upheld as a religious obligation by some groups, it is unlawful in Britain. The Commission is clear that religious or cultural sensitivities are not a reason for any public authority to shy away from its responsibility to take a strong and proactive approach to preventing this form of abuse against girls and young women, supporting victims and rigorously enforcing the law against those who practice it.
Legal position 8. In the Commission’s view, the existing international and domestic legal frameworks are sufficient to tackle FGM effectively, if the authorities responsible made full and proactive use of their powers to act.
Domestic provisions
Criminal law
9. FGM was made a specific criminal offence in the UK by the Prohibition of Female Circumcision Act 1985. This Act was replaced by the Female Genital Mutilation Act 2003 in England, Wales and Northern Ireland, and the Prohibition of Female Genital Mutilation Act (Scotland) Act 2005, both of which extended the offence to cover acts committed by UK nationals outside the UK, thus protecting girls and women being sent abroad for FGM. The 2005 Act also increased the maximum penalty on conviction from five to 14 years imprisonment.
Child protection
228 10. The Children Act 1989 imposes a duty on local authorities in England and Wales to investigate a child's circumstances who they have reasonable cause to suspect is suffering or is likely to suffer significant harm. Given the criminal and harmful nature of FGM, the Commission is clear that once a local authority becomes aware that a child has been or is likely to be subjected to FGM, it has a clear duty to decide what actions it should take to protect the child.
11. If the local authority believes that FGM is likely to be carried out while the child is abroad, it can apply to the court for a Prohibited Steps Order to prevent the child being removed from the UK. A local authority can also apply to the court for an Emergency Protection Order, which gives the local authority parental responsibility and allows it to keep the child in a place of safety.
12. In Scotland, the Children’s Hearing system (governed by the Children’s Hearings (Scotland) Act 2011) has responsibility for dealing with children and young people under 16 who are in need of care and protection. In addition, the Children (Scotland) Act 1995 places a duty on local authorities to safeguard and promote the welfare of children in their area who are in need. Where a child appears to a local authority to be at risk of harm, it may at, the child’s request, provide refuge accommodation.
International legal obligations 13. FGM violates a number of human rights obligations including, because of its role in the sexual, social and economic subjugation of women, the principle of equality and non- discrimination on the basis of sex.
European Convention on Human Rights (ECHR) 14. In the Commission’s view, the practice of FGM engages Article 2 (Right to life) and Article 3 (Prohibition of torture, and inhuman or degrading treatment or punishment) of the ECHR and, given the risks of FGM to the safety of victims, the positive obligation on States under Article 2 to take steps to prevent avoidable losses of life.
UN Convention on the Rights of the Child (CRC)
229 15. Article 24 of the CRC calls for the prohibition of all traditional practices that are prejudicial to the health and wellbeing of children.
UN Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) 16. The UN has called for the elimination of FGM in all girls under 18 years of age, and for all States which accede to CEDAW to take urgent steps to eliminate FGM. The recent Concluding Observations of the UN CEDAW Committee expressed concerns about the persistence of FGM and the lack of convictions to date in the UK.
UN Special Rapporteur on Torture and other Cruel, Inhuman or Degrading Treatment or Punishment
17. The 2008 Report of the Special Rapporteur made clear that “even if a law authorizes the practice, any act of FGM would amount to torture and the existence of the law by itself would constitute consent or acquiescence by the State”. It further stated that FGM “can amount to torture if States fail to act with due diligence”.
Istanbul Convention on Preventing and Combating Violence against Women and Domestic Violence
18. This Convention (signed but not yet ratified by the UK) sets out obligations relating to data collection and research, training of professionals, education and other matters, in respect of violence against women generally and FGM specifically.
The State’s duty to tackle FGM 19. The Commission’s unambiguous and robust position is that FGM amounts to torture and risks the health and lives of girls and women. The continued practice of FGM in Britain is therefore a clear violation of the rights of girls and women, and the lack of effective protection against this violation breaches the State’s international legal obligations. The fact that domestic law prohibits FGM does not fully discharge the State’s obligations; the State is under a positive duty to ensure those at risk have effective protection. Misplaced cultural sensitivity towards communities
230 which practice FGM causes harm to girls and women and fails to protect their human rights.
20. The nature of FGM, the way it is carried out and the means of tackling it place the State’s obligations on a number of public authorities. Meeting those obligations effectively therefore requires a comprehensive and properly co-ordinated and funded strategy involving health bodies, social services, schools, immigration authorities, the police and prosecutors. The role and responsibilities of each of these bodies, and the standards expected of them, need to be set out clearly, and each body must be held to account for fulfilling them. To ensure the approach is co-ordinated and comprehensive, a single body should be nominated to have responsibility for ensuring the overall framework of roles, responsibilities and standards is in place and fit for purpose, and for reporting on overall progress, drawing on performance information from the various authorities.
21. The Commission notes that the UK Governments are taking some steps to tackle FGM. We welcome the clear declaration that FGM is child abuse and an illegal criminal offence. However, in the Commission’s view these steps do not yet amount to the comprehensive approach and concerted action required to meet the State’s obligations. While the successful prosecution of some, and preferably a high proportion, of those who perpetrate the crime of FGM would not be evidence of the State’s fulfilment of its duties, the lack of any such prosecution is, in the Commission’s view, clear evidence of the State’s failure to meet its obligations.
A comprehensive strategy 22. The Commission considers that a comprehensive national strategy to tackle FGM is needed. This needs to have clear leadership, objectives and accountability within Government, assign clear responsibilities and standards to different agencies, involve relevant communities and non-government organisations, and be properly resourced and co-ordinated. It needs to address the problem effectively across the UK, and therefore needs to involve the devolved administrations and devolved agencies and deliver a coherent approach across England, Wales, Scotland and Northern Ireland.
231 23. An effective strategy will include:
24. Prevention through awareness-raising and education – there is a need to raise awareness of FGM and its effects among the communities affected, the wider public and relevant professionals.
25. Work within communities needs to focus on changing attitudes and empowering girls and women to challenge FGM - highlighting the criminal nature of FGM and its effects on the physical and mental well-being of girls and women. This activity must target men as well as women, and older as well as younger generations, in order to challenge traditional values. Such work is likely to be delivered most effectively through community groups with a track record in promoting women’s and girls’ rights, and the Commission welcomes the Government’s recent announcement of a £100,000 Community Engagement Initiative open to charities. However, we consider that the sum committed to this initiative is woefully inadequate given the seriousness of this issue and the intensive engagement needed to reach the right communities and have an impact. The Commission therefore recommends that the Government should consider supplementing this with additional funding, and we are prepared to play our part by using discretionary programme funding to contribute to awareness- raising and empowerment work.
26. There is also a need to raise general public understanding about the abhorrent and criminal nature of FGM, its risks to individuals, and its lack of justification on religious or cultural grounds. This should involve including this topic in PSHE lessons - alongside education on wider issues of violence against women and girls, consent and relationships. We note that the White Paper for the Welsh Government’s Ending Violence Against Women Bill commits 'to ensuring all schools in Wales are supported to provide an age appropriate, healthy relationships programme which will include awareness raising on FGM'.
27. Key professionals including teachers, GPs, midwives, obstetricians, social workers, police, immigration officers and prosecutors should receive mandatory training about FGM to raise their awareness of it and its effects.
232 28. Protection and detection – Teachers, health and social care professionals, the police, immigration officers and non- government organisations working with children and young people have a key role to play in spotting girls at risk of FGM and ensuring that they receive appropriate support and protection. They should therefore receive mandatory training and have access to guidance to help them identify girls at risk of FGM and potential perpetrators, and to help girls at risk and survivors to access appropriate support services. As FGM is a form of child abuse, a core element of training must be to highlight the legal duties on relevant professionals to report any suspicion that a child might be or has been subjected to FGM to police or social services. We endorse the recommendation of the Intercollegiate Group that FGM must be systematically integrated into all UK child safeguarding procedures1. Relevant government departments should take action to remind these key professionals of their duties, and the Commission supports the call by Fahma Mohamed (through change.org) for the Education Secretary to write to all head teachers telling them to inform teachers and parents about the risks of FGM, their responsibilities, and sources of information and support. We welcome the decision by the Education Minister in Scotland to write to head teachers there.
29. Border control officials are well-placed to ensure that families travelling to countries where FGM is prevalent are aware of the risks and the law (for example, through dissemination of the Health Passport which provides information about FGM for girls at risk).
30. Recording and reporting – We welcome the Government’s announcement that NHS hospitals will be required, from April, to record instances of FGM and, from September, to report this data monthly to the Department of Health. This will improve the information available about the number of girls and women who have undergone FGM, which will inform the planning and targeting of prevention strategies and health and support services, and provide a means of monitoring progress in tackling FGM. But this data collection is not a substitute for mandatory reporting and referral requirements on health, education, police and other bodies. FGM is child abuse and must be recognised and treated
1 http://www.rcog.org.uk/news/intercollegiate-group-draws-ground-breaking-recommendations- tackling-female-genital-mutilation
233 as such within existing reporting requirements. Existing sanctions for professionals who fail to report child abuse must be enforced rigorously against those who fail to report children at risk of, or victims of FGM.
31. Particular consideration should be given to circumstances where the presenting FGM survivor is an adult and does not want the crime against her reported to the police. In these circumstances, care must be taken to avoid criminalising the victim and to protect her right to privacy under Article 8 of the ECHR. At the same time, appropriate safeguarding measures must be in place for any female child considered to be at increased risk of FGM due to their relationship with those who practice or support FGM. Whether or not cases of FGM presenting as adult survivors are reported to the police, adult victims should be referred to specialist advice and support services and such services should be properly funded to meet need.
32. Referral for care and repair – Medical professionals should be under a duty to refer all FGM survivors, including adult survivors, to appropriate counselling and medical services. Health and social care services should ensure that there are clear pathways to appropriate counselling and medical services for FGM survivors, including reconstructive or reversal surgery, and should work with communities to ensure that information about these services reaches those who need it.
33. Accountability – As well as holding individual perpetrators of the crime of FGM to account through criminal prosecutions, and enforcing sanctions against professionals failing in their duties to report and refer, there must also be a clear accountability framework to ensure delivery of the action needed by public authorities to eliminate FGM in the UK. This will involve ensuring clarity about the roles of different authorities, embedding requirements and standards into relevant performance frameworks across the public authorities involved, and monitoring progress. However, in order to ensure that the required comprehensive action is delivered across all authorities, we recommend that a single body should have responsibility for ensuring the overall framework of roles, responsibilities and standards is in place and fit for purpose, and for reporting on overall performance and progress, drawing on information from the various authorities. As
234 Britain’s National Human Rights Institution, the Commission has a role in holding public bodies to account for delivery of their human rights obligations so would be well-placed to deliver this function.
Recommendations 34. In summary, we recommend:
• The Government should put in place a comprehensive and co- ordinated UK-wide strategy to tackle FGM, recognising the different legislation, policy, reporting and support systems in place across the countries. The strategy should have clear leadership, objectives, targeted and effective forms of accountability and adequate resources. • More resources should be focussed on prevention through awareness-raising and education in affected communities, with the aim of changing attitudes to FGM. • Key professionals should receive mandatory training about FGM. • Relevant authorities should make clear that FGM is child abuse and as such is subject to existing mandatory reporting requirements. • All relevant professionals should be reminded of their duty to report child abuse, including FGM, under existing safeguarding procedures. • Further work is needed to establish the correct approach to reporting in cases where the presenting FGM survivor is an adult and does not want the crime against her reported to the police, taking account of Article 8 rights to privacy and any increased risks to children. • Health and social care services should work with communities to ensure that information about counselling and medical services for FGM survivors reaches those who need it. • Sanctions against FGM perpetrators and professionals failing in their duties should be enforced robustly. • The Government should ensure there is a clear accountability framework to ensure delivery of the action needed by public authorities to eliminate FGM in the UK, and give a single body
235 responsibility for monitoring and reporting on progress. The Commission is willing to accept this role.
Equality and Human Rights Commission February 2014
236 Written evidence submitted by Alison Macfarlane, Professor of Perinatal Health, City University, London and Efua Dorkenoo, Equality Now and Honorary Senior Research Fellow, City University, London.
1. Background
1.1 Together with Linda Morison, then at London School of Hygiene and Tropical Medicine, we produced the first estimates of the prevalence of female genital mutilation in England and 1 Wales. These were published by FORWARD in 2007. These estimated that 66,000 mainly African women aged 15-49 resident in England and Wales in 2001 had undergone female genital mutilation and 24,000 girls under the age of 15 largely from African communities were at high risk of WHO Type III FGM and nearly 9,000 were at high risk of WHO Type I or Type II FGM.
1.2 The estimates of FGM provided in this study have been widely cited and highlight the need for action to both provide appropriate care for affected women and protect their daughters from FGM. We also estimated that the prevalence of FGM among women giving birth in England and Wales rose from 1.06 per cent in 2001 to 1.43 per cent in 2004 but this has been less widely cited.1
1.3 Much has changed since the original estimates of the prevalence of FGM in England and Wales were produced. The numbers of women who have migrated from some FGM practising countries, notably Somalia and the rest of the Horn of Africa have increased considerably, as have the numbers of births in England and Wales to women born in these countries. More recent population data are now available from the 2011 census. This means that it is timely to produce new estimates and we have been funded to do so through grants from the Home Office and the Trust for London. These will be published in the coming months and we hope they will be available before the Committee finalises its report.
1.4 This submission describes the approach to be used, including its strengths and limitations and how it is planned to use the information. This means that we have not attempted to answer all the questions.
2. Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
2.1 Data about the prevalence of FGM in countries where it is known to be practised were reviewed by UNICEF in a report published in 2013.2 Most of the information come either from the Demographic and Health Surveys funded by USAID3 or the Multiple Indicator Cluster Surveys developed by UNICEF.4 These surveys are undertaken at approximately five yearly intervals in countries which do not have routine systems for collecting health information. The UNICEF report showed decreases in prevalence in some countries but not in others as well as wide variations between geographical areas and ethnic and socio-economic groups.
2.2 No realistic and reliable methods have so far been developed for collecting data on the prevalence of female genital mutilation in Western countries. A methodological workshop funded by the Home Office and held in March 2012 discussed the range of research on FGM under way in the UK and in other western countries.5
237 2.3 The aims of our current project are:
(i) To use data from surveys in FGM practising countries and from other sources to derive updated proxy estimates of the prevalence of FGM among women born in the FGM practising countries and among their daughters.
(ii) To apply these to data collected at birth registration in England and Wales to produce updated and more reliable estimates of: a. Numbers of women with FGM living in England and Wales and in each local authority area giving birth each year from 2000 to 2011 b. Numbers of daughters born to women born in FGM-practising countries resident in England and Wales and in each local authority area.
(iii) To produce updated and more reliable estimates of numbers of women born in FGM practising countries and numbers of women with FGM living in England and Wales as a whole and in each local authority area in 2011.
2.4 As with the previous project,1 the project under way will draw on the surveys undertaken in the FGM practising countries to derive proxy estimates of prevalence rates and apply these to the numbers of women born in those countries who were enumerated in the 2011 census or gave birth here. This is a good time to update and improve the earlier estimates. Since they were produced, there is new population data from the 2011 census, some improvements have been made to national migration statistics and further surveys have been undertaken in the FGM practising countries in which women were born. Proxy prevalence rates will be derived from these surveys and used to produce updated and improved estimates of numbers of women with FGM and numbers of girls born to them.
2.5 The previous national estimates for England and Wales were derived from a table of counts of numbers of women tabulated by country of birth and age group. For the new estimates, anonymised census data will be analysed by other factors, including ethnicity, religion, first language and age on arrival in the UK and these will compared with within country prevalence rates from the surveys. Data from birth registration will be used to estimate the prevalence of FGM among women giving birth and the numbers of daughters born.
3. How can the systems for collecting and sharing information on FGM be improved?
3.1 The Department of Health is about to start piloting data collection from women using health services and has consulted us and others for advice, It has asked us to continue to give advice as the piloting proceeds.
4. How can the available support and services be improved for women and girls in the UK who have suffered FGM?
4.1 We anticipate that the Committee will have received extensive information in response to this question and adding to this is outside the scope of this memorandum. Our project aims to provide local authorities with information about their populations to inform their choice of services, support and preventive strategies which are appropriate to their populations.
238 4.2 As well as national headline figures, prevalence estimates and estimated numbers of women with FGM giving birth and daughters born to them will be produced for residents of each local authority. Where the estimates are based on very small numbers, a verbal description will be substituted to avoid publishing data which might identify individuals. We anticipate that, as with our previous estimates, there will be areas where prevalence is very low, but that there will be nowhere where it is zero.
4.3 This information will be disseminated widely to local authorities, NHS professionals and third sector organisations in order to inform improvements in services for affected women and to try to prevent FGM in their daughters.
Alison Macfarlane, Professor of Perinatal Health, City University, London Efua Dorkenoo, Equality Now and Honorary Senior Research Fellow, City University, London February 2014
References 1. Dorkenoo E, Morison L, Macfarlane A. A statistical study to estimate the prevalence of female genital mutilation in England and Wales. Summary report. London: Foundation for Women’s Health, Research and Development (FORWARD). 2007. www.londonscb.gov.uk/files/resources/fgmsummary_report_10_october2007.pdf. 2. United Nations Children’s Fund, Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change, UNICEF, New York, 2013. http://www.unicef.org/protection/57929_58002.html Accessed 21 February 2013. 3. Measure DHS. Demographic and Health Surveys. http://www.measuredhs.com/ Accessed 21 February 2013. 4. UNICEF. Multiple Indicator Cluster Survey. (MICS) http://www.unicef.org/statistics/index_24302.html Accessed 21 February 2013. 5. Equality Now. Female genital mutilation. Report of a research methodological workshop on estimating the prevalence of FGM in England and Wales. London, March 22-23, 2012
239 Written evidence submitted by the Crown Prosecution Service
Executive summary
• The Crown Prosecution Service (CPS) is determined to bring a successful prosecution for Female Genital Mutilation (FGM).
• FGM has been a specific criminal offence in England and Wales since 1985, but no prosecution has ever been brought for FGM.
• The CPS is now currently considering 10 cases (at 12 February 2014).
• The CPS is working towards bringing a prosecution in the near future to secure a FGM conviction in court.
• The CPS and the police have been working together to ensure there are effective arrangements in place to support investigations and prosecutions, and identifying ways to overcome any potential barriers.
Introduction
1. The Crown Prosecution Service (CPS) was set up in 1986 under the Prosecution of Offences Act 1985 as an independent authority to prosecute criminal cases investigated by the police in England and Wales. In undertaking this role, the CPS: • advises the police during the early stages of investigations; • determines the appropriate charges in more serious or complex cases; • keeps all cases under continuous review and decides which cases should be prosecuted; • prepares cases for prosecution in court and prosecutes the cases with in- house advocates or instructs agents and/or counsel to present cases; and • provides information and assistance to victims and prosecution witnesses.
2. Before charging a defendant and proceeding with a prosecution, prosecutors must first review each case in accordance with the Code for Crown Prosecutors. The Code sets out the principles which prosecutors follow when considering cases. The key principles are that a prosecution should only be started or allowed to continue if there is enough evidence to provide a realistic prospect of conviction against each defendant on each charge, and, if so, where a prosecution is needed in the public interest.
3. The Code for Crown Prosecutors is supplemented by legal guidance for prosecutors which provides a detailed framework within which prosecutors take their decisions in individual cases to ensure consistency of approach throughout England and Wales. The guidance is publicly available via the CPS website.
240 4. Alison Saunders is the Director of Public Prosecutions (DPP) and heads the CPS. She has been DPP since November 2013 and was previously the Chief Crown Prosecutor (CCP) for London.
5. The CPS is divided into 13 geographical Areas across England and Wales. Each Area is led by a CCP who is responsible for the provision of a high quality prosecution service in his or her Area. A non-geographical ‘virtual’ 14th Area, CPS Direct, is also headed by a CCP and provides charging decisions to the police, 24 hours per day 365 days of the year. The CPS also has a small Headquarters function and four central casework divisions - Central Fraud Division, Serious Crime and Counter Terrorism Division, Organised Crime Division and Welfare, Rural and Health Division.
Background on referrals to the CPS
6. Female Genital Mutilation (FGM) has been a specific criminal offence in England and Wales since 1985 when the Prohibition of Female Circumcision Act 1985 (“the 1985 Act”) was passed.
7. The Female Genital Mutilation Act 2003 (“the 2003 Act”) repealed and replaced the 1985 Act in England, Wales and Northern Ireland. It also made it an offence for UK nationals or permanent UK residents to carry out FGM abroad, or to aid, abet, counsel or procure the carrying out of FGM abroad, even in countries where the practice is legal. The maximum penalty was also increased from 5 years to 14 years imprisonment.
8. However, no prosecution has ever been brought for FGM in the intervening 29 years, either for the more limited offence introduced in 1985 or for the more extended offence introduced in 2003. Although there have been a number of police investigations, we are unaware of any cases being referred to the CPS for a decision to charge prior to 2010.
9. The first case referred to the CPS was in 2010 when the decision was taken not to charge because the victim had given several different accounts of what happened, implicating different perpetrators, on different dates and in different countries. Even allowing for the possibility that trauma and other reasons may have affected the accounts given; the reviewing CPS lawyer concluded that without any supporting evidence and with the victim accepting that some of her accounts were false, no charges could be brought. This case is now being re- reviewed by the CPS.
10. Since then the CPS has taken the decision not to charge in two further cases. One case was referred to the CPS by the police for advice in 2012 as there was an allegation that a girl may have been at risk of FGM. The police initiated an investigation which included the arrest and interview of the girl’s parents and the seizure and search of computers, phones and other documentation The police investigation did not find evidence that the girl was at risk, and following advice from the CPS, no further action was taken. Another case was referred to the CPS in January 2013, following which the victim withdrew her allegation and despite offers of specialist support and special measures was no longer willing to support a prosecution. Due to the victim’s health and vulnerability we
241 concluded that witness summons would not be appropriate and as a result determined that no further action should be taken.
11. In a third case the decision not to charge was taken in September 2012. In this case, the CPS decided that no further action should be taken and no charges brought as there was insufficient evidence to support the allegation made in a newspaper report that two medical doctors in Birmingham were willing to undertake FGM on girls.
12. The CPS is now currently considering 10 cases. Four of the cases are reviews of “old” cases from the Metropolitan Police Service (MPS) where the police or prosecutors decided that no further action should be taken, this includes the first case referred to the CPS in 2010, as detailed above. Six are new cases referred by the MPS, although three are at a very early stage, and the CPS is advising on the investigations. No decisions have yet been taken on the 10 cases (as of 12 February 2014) but they are subject to frequent review by the CCP for London, and there is close cooperation between CPS London and the MPS. We also understand West Midlands Police are currently investigating a potential case (as of 12 February 2014) which may be referred to CPS West Midlands for early investigative advice shortly.
Barriers to prosecution
13. The CPS is determined to bring a successful prosecution. However, there are a number of barriers that need to be overcome in doing so. This it should be made clear is not to excuse the lack of prosecutions, but rather it is to identify the challenges that the CPS is working with its partners to overcome.
Reports of FGM
14. The CPS can only prosecute cases referred by the police following an investigation. However, there are relatively few cases reported to the police for investigation. At the time that FGM takes place, many victims may be too young and vulnerable or too afraid to report offences to the police. We also recognise that victims may not wish to report their parents, and there remains reluctance to report the crime to the police because of cultural issues, including pressure from the family and the wider community.
15. Even when a victim comes forward or someone reports a suspected case of FGM to the police, the police face a number of problems when conducting their investigation. For example, this can include silence from the community; evidential and other difficulties if the FGM is reported many years after the act has taken place; and the FGM may take place outside of our jurisdiction which means there may be challenges in obtaining reliable and admissible evidence from the country where the FGM took place. There is also the problem that the victim’s evidence may not be reliable enough because of a number of factors such as their age or inability to recollect what happened.
16. If very few victims are therefore likely to come forward and complain to the police, we need to identify other means of identifying girls and women who have been subjected to FGM or who are at risk of FGM. A very important source of
242 potential referrals to the police should be health professionals and schools. In particular, health professionals will come into contact with girls and women who have been subjected to FGM or with girls at risk. For example, midwives will see women when giving birth who have had FGM committed on them. Schools should be aware and alert if a girl is removed from school for an extended period to holiday outside the UK during the so-called “cutting season”. Work needs to be undertaken by the responsible departments, agencies and professional bodies to ensure that frontline professionals are aware of FGM and they clearly understand how to report any suspected cases so that action can be taken. A new statutory duty to report suspected cases on health and education professionals would be helpful as it would require an effective response.
17. In addition, to overcome the problem of few victims coming forward, we are pleased that the police are instigating more covert and intelligence led operations against FGM, especially if they are able to identify the “cutters” carrying out the FGM.
Building the evidential case
18. In order to have sufficient evidence of FGM for a prosecution, a full picture is required to provide a realistic prospect of conviction with evidence to show that FGM has taken place and identify the person(s) responsible. Ideally an account is needed from the victim; evidence that the suspect/s undertook the act concerned or aided, abetted, counselled or procured the act; medical evidence to prove that FGM has taken place; and other extraneous evidence involving the parents or other adults suspected of being involved such as travel documents, emails concerning the arrangements, texts and bank details showing payments or withdrawals.
19. If the evidence outlined can prove all the elements of the offence without the need to call the victim to give evidence, a prosecution may be possible without them.
20. In circumstances where a victim feels that they are unable to proceed, the CPS will still look to see if it is still possible to charge and prosecute for FGM or any other criminal offences which might be disclosed by the investigation. Here, the prosecutor will consider if there is other sufficient evidence available which will support the offence to the criminal standard without relying on the victim to give evidence of the offence. This evidence might include a combination of expert medical evidence, evidence from third parties such as schools or local authority records, evidence which might come from passports or flight records or other close family members or friends. However, unless a victim comes to the attention of the relevant authorities, it is unlikely that action can be taken.
Support for victims
21. Many witnesses experience stress and fear during the investigation of a crime and subsequently when attending court and giving evidence. The CPS has particular obligations under the Code of Practice for Victims of Crime (the
243 Victims Code). This includes discussing with the police as soon as possible the victim’s requirements for giving evidence. Once the needs of the victim has been identified, the prosecutor can then apply to the court for “special measures” which are a range of provisions to help vulnerable and intimidated witnesses give their best evidence in court. The decision to grant special measures is a matter for the court.
Special measures available to the victim in court include:
• Screens;
• Live links;
• Evidence given in private;
• Removal of wigs and gowns by judges and barristers;
• Video recorded interview;
• Examination of the witness through an intermediary; and
• Aids to communication.
22. The CPS can also arrange court familiarisation visits through the relevant Witness Care Unit so that the victim is aware of the layout of the court and to help demystify the process.
23. If there was information to suggest that the victim was reluctant to give evidence in court, enquiries must be made with the police with regard to the safety of the victim and to ascertain whether the victim has been made aware of available specialist support. If specialist support services are involved, a risk assessment should be considered, especially in higher risk cases. However, if the victim was still unwilling to give evidence, the CPS would take the following action:
• Make an application to the court for appropriate Special Measures to protect and support the victim when giving evidence at court;
• Request the police to take a retraction statement from the victim to explain the reasons behind the retraction. If intimidation or fear are issues, prosecutors can consider other offences of witness intimidation;
• consider other evidence available and the possible use of hearsay provisions where relevant; and
• If it is still in the public interest to proceed, taking the victim’s safety into account, the prosecutor could consider applying for a witness summons as a last resort.
244 24. If having taken the above action and the victim was still unwilling to give evidence, prosecutors should consider any other offences with which to charge the suspects where they do not need to rely on the victim’s testimony.
Action being taken by the CPS
25. The CPS has taken a leading role in addressing FGM in recent years. We have been working with our partners to ensure there is a robust framework in place that is able to support the effective investigation and prosecution of FGM.
26. In September 2011, the CPS published its first specific piece of guidance for prosecutors on dealing with FGM. This included advice about the sensitivities and complexities involved in FGM. This was followed in September 2012 by a roundtable chaired by the then DPP with the police, third sector organisations, professional bodies, government, departments and experts, to explore why so few FGM cases were being referred to the CPS for charge and prosecution, to consider how we could work together to address some of the challenges faced in the reporting of cases to the police and investigating and gathering evidence in order to support a prosecution. This led to an action plan being published by the CPS that autumn. The actions have led to much closer joint working between the police and CPS on this issue.
27. It included the production of an Aide Memoire by the CPS on offences and behaviours experienced by victims of FGM. The Aide Memoire set out a range of relevant inchoate offences (including conspiracy); section 5 of the Domestic Violence, Crime and Victims Act (DVCVA) 2004 (amended by DVCVA 2012); and other offences associated with assault, abuse and neglect. The document has been published as part of the CPS guidance on FGM and published on the Police National Database. It provides advice on alternative offences if the FGM offences cannot be pursued.
28. A follow-up roundtable was held in September 2013 and a new action plan was agreed. Since Alison Saunders became Director of Public Prosecutions in November 2013, protocols have been agreed between the CPS Areas and every local police force setting out the arrangements for working together and tackling FGM locally. The protocols set out how each case will be considered, as well as stressing the importance of making sure the victim is supported in every way possible. It calls for early consultation between the CPS lawyer and the officer in the cases to ensure that all possible avenues of evidence are explored and that the correct charge is identified. The DPP has also identified prosecutors to lead on FGM in each of the 13 CPS Areas and CPS Direct. They will be the lead contact with the police and communities, for instance the CPS London lead liaises with the MPS specialist FGM unit. As a result of this work, the CPS is now much better prepared to identify cases where there is sufficient evidence for a realistic prospect of conviction.
29. The DPP wrote to Ministers in the Home Office, Ministry of Justice and Department of Health (with copies to the Department for Education and the Department of International Development) on 3 February 2014 identifying possible ways in which the criminal law could be strengthened. The proposals
245 include clarifying the law in relation to “re-infibulation” as it is not explicitly referred to in the 2003 Act; extending the scope of extra-territorial offences so that those with temporary residency status in the UK are covered effectively by the 2003 Act; placing a positive duty on parents or carers to prevent their child from being mutilated by another or on the instigation of another; and a new statutory duty on health and education professionals to report cases where they suspect a girl has undergone FGM or is at risk of FGM. This was reinforced and circulated under cover of a letter from the Solicitor General who has been very supportive of the FGM work undertaken by the CPS and to whom regular updates are provided. We understand the proposals are currently being considered. 30. The DPP attended a Ministerial FGM Roundtable on 6 February 2014, hosted by the Home Office and chaired by Norman Baker MP, on the International Day of Zero Tolerance to Female Genital Mutilation. At that meeting, the DPP signed a Ministerial declaration to prevent and put an end to FGM. The Solicitor General who is a keen supporter of this work was in attendance and is also a signatory to the declaration. 31. A joint CPS/police national training event was also held at CPS Headquarters on 10 February 2014 and attended by prosecutors and police officers from across England and Wales. This was the first time such a national event had been held and was used to raise awareness of relevant investigation and prosecution strategies through working on hypothetical case studies. This is being seen as a model for further CPS/police training events on FGM.
Conclusion
32. The fact there have been no prosecutions of FGM since it became illegal in 1985 is a matter of which the CPS is very aware and is determined to change. We are working towards bringing a prosecution in the near future to secure a FGM conviction in court. We and the police have been working together to ensure there are effective arrangements in place between us to support investigations and prosecutions, and identifying ways to overcome any potential barriers. There remains work to be done to improve the number of reports to the police, but there is now significantly greater awareness of this issue than there was just a few years ago. FGM will continue to be a priority for the CPS for the foreseeable future.
Crown Prosecution Service February 2014
246 Written evidence submitted by Yana Richens OBE
WITH REGARDS TO PREGNANT WOMEN IDENTIFIED AS HAVING FGM
1. Guidance for Midwives Urgently Required
• A clear strategic decision must be made as to whether or not all pregnant women with FGM should be routinely referred to the Police and/or Social services
1. The main risk factor for FGM is to be born into a community that practises FGM. This means the unborn daughters of pregnant women with FGM are at risk. 2. All pregnant women in the UK will come into contact with a midwife at some point during their pregnancy. This may be the only contact they have with a health care professional and is therefore a unique opportunity for prevention of FGM. 3. Currently there are no clear guidelines on when midwives should refer pregnant women with FGM to the police and/or social services. 4. At present only a handful of pregnant women are referred by midwives to the police and social services. 5. As at least 50% of FGM is performed on girls over the age of 5 years, it is impossible for midwives to predict which families will procure FGM in the future and which will not. 6. A policy of blanket referral of all pregnant women with FGM to the police of social services would mean midwives would not have to predict when a crime might be committed several years in the future. 7. However in some hospitals up to 5% of women have FGM and the referral of large numbers of women would overwhelm police and social services. Extra services would need to be established and funded. 8. Women need to be referred to sensitive and knowledgeable services. This means that social services and the police would need to identify and train their workers to manage women appropriately. This will require funding.
2. Guidance for Police and Social Services Urgently Required.
• A clear strategic decision must be made as to further follow-up of pregnant women with FGM following referral to the Police and/or Social services
1. If all pregnant women are routinely referred to the police and social services, the majority will be found not to have committed a crime. This may be because they do not intent to perform FGM on their daughter or because FGM is often deferred for several years. In addition in some families FGM may be performed against the wishes of the parent.
247 2. At present there is no guidance as to management of these women after an initial assessment where FGM has not happened but may happen in the future. 3. There is no clear strategy for following pregnant women with FGM and their unborn children up after delivery. 4. There is no clear strategy for surveillance of these children. For example should they have regular genital examinations? If so, how often and by whom? 5. Would data from women with FGM be kept on a database? If so what information would be recorded? Who would have access to this? How would such information be shared between agencies? What are the implications for the civil liberties of keeping data on a specific group of women when no crime has yet been committed?
Authors
Yana Richens OBE
Sarah Creighton
Declaration of Interests
Yana Richens is a Consultant Midwife in Public Health at University College Hospital London. She is a current and founder member of the FGM National Clinical Group
Sarah Creighton is a consultant gynaecologist and honorary clinical professor at University College Hospital London. She is a past and founder member of the FGM National Clinical Group
248
Written evidence submitted by the Royal College of General Practitioners
Introduction
1. The Royal College of General Practitioners (RCGP) is the largest membership organisation in the United Kingdom solely for GPs. Founded in 1952, it has over 49,000 members who are committed to improving patient care, developing their own skills and promoting general practice as a discipline. We are an independent professional body with extensive expertise in patient-centred generalist clinical care.
2. Our response is written from the perspective of general practice only.
How effective is the existing legislative framework on FGM, and what are the barriers to achieving a successful prosecution in the UK?
3. Given that, to this date, there have been no UK convictions for performing FGM, it is difficult to draw conclusions on the operation of the existing legislative framework.
4. We know that FGM takes place within the UK and is also performed on women and girls (even from infancy) when visiting their family in their country of origin from the UK. Under the Female Genital Mutilation Act 2003 the offender and affected girl or woman both need to be UK nationals or permanent UK residents in order to ensure conviction where FGM is performed abroad. However, often those who suffer from or take part in FGM are only temporary UK residents.
5. The RCGP views FGM as child abuse, as the child has been subjected to irreparable physical harm. If it is suspected by a GP that a child has undergone FGM then the parent(s) or guardian(s) should be referred to social services who should have the means to deal with it accordingly.
6. The RCGP does not feel in a position to comment on barriers to successful prosecution. However, we recommend that the Committee consider whether enough is being done to prosecute health professionals who perform FGM, particularly where a medical professional has been struck off for this reason.
7. It would help if GPs were made aware of the kind of evidence they could collect to provide good objective evidence of FGM, to allow prosecutions to go ahead even when a victim changes their story.
Which groups in the UK are most at risk of FGM (whether in this country or abroad), and what are the barriers to identification and intervention?
8. Women and girls who have been affected by FGM are usually pre-pubertal but infants and adult women are also targeted. A map produced by UNICEF gives the number and percentage of women and children that have been affected. The highest rate is 98% in Somalia.1
1 Unicef, Female Genital Mutilation/Cutting, 2013 http://www.unicef.org/media/files/FGCM_Lo_res.pdf
249
9. FGM is much more common if the child’s mother or sister have been already affected.
10. There are a number of possible barriers to identification by GPs, such as:
• A lack of awareness of the risk factors that suggest a patient may be affected by FGM. Unfortunately there is a lack of adequate data on communities and individuals who are affected by FGM within the UK. It is likely that this is impacting on the ability of GPs to judge which of their patients may be at risk. • Cultural sensitivity issues. GPs may feel unable to raise the issue sensitively with members of affected communities. • FGM may not be clinically apparent to a GP who does not often conduct intimate examinations, especially if it is Type 1 (clitorectomy) in a pre-pubertal girl. Less extensive surgery may still be as serious in terms of infection (including HIV and other blood borne viruses), pain and subsequent mental health problems. • Difficulty asking questions sensitively, but directly. • Language and communication problems. There has been less access to translation services in recent years due to cut-backs within the health service.
11. In France routine examinations of the genitalia of young girls has led to a higher rate of prosecution. While the RCGP appreciates that routine screening can have positive outcomes, we have concerns that a screening programme of this type could alienate hard to reach individuals and communities, and could in itself be a traumatic experience.
12. Barriers to intervention by GPs include:
• Difficulty obtaining consent to the examination • The desire to maintain patient confidentiality. • Worries about the consequences of referral to police and social services for the family if wrong
13. There are a number of resources currently available for GPs, such as:
• Department of Health (2011) Female genital mutilation: multi-agency practice guidelines 2 • BMA Ethics: Female Genital Mutilation: Caring for patients and safeguarding children 2011.3 and Tackling FGM in the UK: Intercollegiate recommendations for identifying, recording and reporting 4 • The RCGP has also helped to draw up a number of resources on FGM for use within primary care:
2 Department of Health, Female Genital Mutilation: Multiagency guidelines https://www.gov.uk/government/publications/female- genital-mutilation-multi-agency-practice-guidelines 3BMA, Female Genital Mutilation: Caring for patients andsafeguarding children 2011 http://bma.org.uk/- /media/Files/PDFs/Practical%20advice%20at%20work/Ethics/femalegenitalmutilation.pdf. 4 Royal College of Obstetrician and Gynaecologists, Intercollegiate Group draws up ground-breaking recommendations for tackling Female Genital Mutilation http://www.rcog.org.uk/news/intercollegiate-group-draws-ground-breaking-recommendations-tackling-female-genital-mutilation
250 I. The Primary Care Child Safeguarding Forum (PCCSF) is a Primary Care Society affiliated to the RCGP and has recently produced a Statement on Female Genital Mutilation. II. The RCGP has been involved in a major piece of work on FGM, led by our colleagues at the Royal Colleges of Midwives and Obstetricians & Gynaecologists, amongst others. This is focussed on helping to raise clinician awareness of this problem, which affects some of the most vulnerable girls and women in our society. The report Tackling FGM in the UK looks at the role that all health and social care professionals - including GPs - have in identifying and reporting cases of FGM. III. The RCGP in conjunction with the NSPCC had previously developed a toolkit for health professionals on safeguarding children and young people, including advice of relevance to cases of FGM.5
14. The March 2013 Department for Education publication of “Working together to safeguard children”6 does not mentioned FGM in any meaningful detail. This reinforces the feeling that child protection and combating FGM are not properly strategically aligned.
15. There appears to be no data on the incidence of health impacts of FGM, either over the short or long term. We know there are consequences which may be serious but not how often these occur and therefore have no indication of how often these might be encountered in General Practice.
What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi-agency co-operation be improved?
16. GPs have a number of different roles to play in combating FGM;
• Identification. There are a number of clinical situations when GPs and practice nurses may be able to identify patients who have been affected by FGM. These include: i. The registration of new patients from affected communities. ii. At the start of pregnancy in women from affected communities. iii. Patients presenting with symptoms that may suggest they have been affected by FGM. iv. Instances when patients from affected communities refuse cervical cytology or experience pain or distress during the test.
• Recording. GP systems have a specific code to record FGM. This has the potential to be a valuable tool in recording and combating FGM • Supporting with compassion and understanding those that have been affected. • Referring. As the main point of entry into the health service for the majority of patients, GPs have a duty to refer patients to relevant secondary bodies.
5 RCGP and NSPCC, Safeguarding Children and Young People A Toolkit for General Practice, 2011 http://www.rcgp.org.uk/~/media/Files/CIRC/Safeguarding%20Children%20Module%20One/Safeguarding-Children-and-Young- People-Toolkit.ashx 6 Department for Education, Working together to safeguard children, 2013 http://www.education.gov.uk/aboutdfe/statutory/g00213160/working-together-to- safeguard-children.
251 However, in order to do this for patients affected by FGM there need to be clear pathways of care and thresholds for referral to police, social and other relevant services, including mental health. Local Safeguarding Boards (LSGB) need to be encouraged to develop their local multi-agency procedures to clarify these. In addition some women and children will need specialist FGM support services, for the physical and/or psychological consequences of their trauma. The RCGP does not think adequate support services currently exist, except in small pockets within some large cities. • Raising awareness. The RCGP has helped to produce a number of documents aimed at GPs which contain advice on how to address FGM (detailed in paragraph 14 above). In addition, GPs should feel free to display posters and have leaflets in their surgeries, especially if they are in an area with a high prevalence of FGM.
How can the systems for collecting and sharing information on FGM be improved?
17. The RCGP has significant concerns over the lack of detailed data on the prevalence of FGM within the UK, as planning of services cannot be adequately undertaken without knowledge of the scale of the problem. All health workers who come into contact with those who have been affected by FGM should be encouraged to record this fact. This is particularly true of those who work in obstetrics, gynaecology, paediatrics and mental health.
How effective are existing efforts to raise awareness of FGM?
18. As there is no baseline data available on awareness of FGM within the UK, it is difficult to draw any concrete conclusions on how effective efforts have been to improve this. In addition there is not enough research available on which to base conclusions regarding the effectiveness of existing awareness campaigns.
How can the available support and services be improved for women and girls in the UK who have suffered FGM?
19. The available support and services can be improved by: • Developing specific care pathways for FGM that involve health, education, and social services. • Developing a way for general practice and other relevant health bodies to identify those at risk from FGM. • Engaging with affected communities by identifying and supporting people to work in a culturally sensitive way within the affected communities. • Making culturally sensitive specialist FGM services available, especially for long term psychological consequences, including PTSD. • Publicising available support services such as the dedicated NSPCC helpline. • Improving the evidence base through research into the epidemiology of FGM in the UK, its association with other forms of child abuse, long term outcomes for those affected, and the effectiveness of interventions.
Other matters that may be relevant to the inquiry
252 20. The RCGP views FGM as child abuse and believes that it should be treated as such by all governmental agencies. However we have concerns around the capacity of social services to respond to referrals. We would like to see care pathways and thresholds for referral clarified and developed nationally and at local LSGB levels.
Acknowledgements 21. The contributions of Drs Judy Shakespeare, Amber Janjua, Janice Allister and Vimal Tiwari are acknowledged.
Royal College of General Practitioners February 2014
253 Written evidence submitted by Graham Senior-Milne
This is the submission of Graham Senior-Milne to the Home Affairs Committee in response to its call for evidence in relation to FGM.
Every FGM victim in the UK could sue the government for failure to protect them from inhuman and degrading treatment under the European Convention on Human Rights (ECHR), Article 3 (Prohibition on torture, inhuman or degrading treatment or punishment). It would only take ONE successful case to FORCE the government to take this issue seriously (because the government would be liable for all other similar cases).
ECHR case law has established that:
1. a positive obligation to protect people from inhuman and degrading treatment (i.e. not just a negative obligation not to inflict inhuman and degrading treatment), including inhuman and degrading treatment by private persons (i.e. people who are not state officials) as well as state officials;
2. a duty to carry out effective and practically independent official investigations into allegations or indications of such treatment;
3. a duty to carry out such investigations in response to complaints or where no complaint is made but where there are sufficiently clear indications of inhuman and degrading treatment;
4. a duty to carry out such investigations with 'promptness and reasonable expedition'.
5. a duty to carry out investigations that are capable of identifying and punishing those responsible (i.e. an official investigation which is not allowed to allocate blame, such as the Francis Enquiry into the Mid-Staffordshire NHS Foundation Trust scandal, does not fulfil the government's legal obligation).
6. a duty to allow the victim to 'to participate effectively in the investigation in one form or another'.
In summary:
1. the state has a positive obligation to protect people from inhuman or degrading treatment both by state officials and by private persons;
2. where there are sufficient indications (and also where the state 'ought to have been aware' - see below) of inhuman or degrading treatment of any person within its jurisdiction, either by state officials or by private persons, the state has a positive obligation to carry out an effective and independent investigation with 'promptness and reasonable expedition' which is capable of identifying and punishing those responsible and which allows the victim to participate effectively in the investigation in one form or another, which necessarily implies telling the victim of the possible breach (i.e. it is unlawful for the state to conceal a possible breach from the victim);
254 3. failure to carry out an effective investigation into a possible breach of article 3 may amount to a further breach of article 3 'because the actions or failures to act on the part of the judicial authorities have themselves caused such anguish to those seeking a remedy'.
This means that the government is liable for failing to protect FGM victims where it OUGHT TO HAVE BEEN AWARE of their maltreatment. The government knew that FGM was/is prevalent in some communities and should have taken steps to protect potential victims (e.g. by establishing inspection procedures when people visit their GP and so on). The fact that the government ought to have been aware of their maltreatment and wasn't through its own failure to act makes it liable under ECHR Article 3 case law. http://hudoc.echr.coe.int/sites/eng/pages/search.aspx?i=001-58559
CASE OF LABITA v. ITALY (Application no. 26772/95)
'120. The Court recalls that ill-treatment must attain a minimum level of severity if it is to fall within the scope of Article 3. The assessment of this minimum is relative: it depends on all the circumstances of the case, such as the duration of the treatment, its physical and mental effects and, in some cases, the sex, age and state of health of the victim. In respect of a person deprived of his liberty, recourse to physical force which has not been made strictly necessary by his own conduct diminishes human dignity and is in principle an infringement of the right set forth in Article 3 (see the Tekin v. Turkey judgment of 9 June 1998, Reports 1998-IV, pp. 1517-18, §§ 52 and 53, and the Assenov and Others judgment cited above, p. 3288, § 94).
Treatment has been held by the Court to be “inhuman” because, inter alia, it was premeditated, was applied for hours at a stretch and caused either actual bodily injury or intense physical and mental suffering, and also “degrading” because it was such as to arouse in its victims feelings of fear, anguish and inferiority capable of humiliating and debasing them. In order for a punishment or treatment associated with it to be “inhuman” or “degrading”, the suffering or humiliation involved must in any event go beyond that inevitable element of suffering or humiliation connected with a given form of legitimate treatment or punishment. The question whether the purpose of the treatment was to humiliate or debase the victim is a further factor to be taken into account (see, for instance, V. v. the United Kingdom [GC], no. 24888/94, § 71, ECHR 1999-IX, and the Raninen v. Finland judgment of 16 December 1997, Reports 1997-VIII, pp. 2821-22, § 55), but the absence of any such purpose cannot conclusively rule out a finding of violation of Article 3.
121. Allegations of ill-treatment must be supported by appropriate evidence (see, mutatis mutandis, the Klaas v. Germany judgment of 22 September 1993, Series A no. 269, pp. 17- 18, § 30). To assess this evidence, the Court adopts the standard of proof “beyond reasonable doubt” but adds that such proof may follow from the coexistence of sufficiently strong, clear and concordant inferences or of similar unrebutted presumptions of fact (see the Ireland v. the United Kingdom judgment of 18 January 1978, Series A no. 25, pp. 64-65, § 161 in fine).
122. In the instant case, the ill-treatment complained of by the applicant consisted of, on the one hand, being slapped, blows, squeezing of the testicles and baton blows and, on the other, insults, unnecessary body searches, acts of humiliation (such as being required to remain in handcuffs during medical examinations), intimidation and threats.'
....
255
'131. The Court considers that where an individual makes a credible assertion that he has suffered treatment infringing Article 3 at the hands of the police or other similar agents of the State, that provision, read in conjunction with the State's general duty under Article 1 of the Convention to “secure to everyone within their jurisdiction the rights and freedoms defined in ... [the] Convention”, requires by implication that there should be an effective official investigation. As with an investigation under Article 2, such investigation should be capable of leading to the identification and punishment of those responsible (see, in relation to Article 2 of the Convention, the McCann and Others v. the United Kingdom judgment of 27 September 1995, Series A no. 324, p. 49, § 161; the Kaya v. Turkey judgment of 19 February 1998, Reports 1998-I, p. 324, § 86; and the Yaºa v. Turkey judgment of 2 September 1998, Reports 1998-VI, p. 2438, § 98). Otherwise, the general legal prohibition of torture and inhuman and degrading treatment and punishment would, despite its fundamental importance (see paragraph 119 above), be ineffective in practice and it would be possible in some cases for agents of the State to abuse the rights of those within their control with virtual impunity (see the Assenov and Others judgment cited above, p. 3290, § 102).'
http://hudoc.echr.coe.int/sites/eng/pages/search.aspx?i=001-80395
CASE OF 97 MEMBERS OF THE GLDANI CONGREGATION OF JEHOVAH’S WITNESSES AND 4 OTHERS v. GEORGIA (Application no. 71156/01)
'96. In general, actions incompatible with Article 3 of the Convention incur the liability of a contracting State only if they were inflicted by persons holding an official position. However, the obligation on the High Contracting Parties under Article 1 of the Convention to secure to everyone within their jurisdiction the rights and freedoms defined in the Convention, taken in conjunction with Article 3, requires States to take measures designed to ensure that individuals within their jurisdiction are not subjected to torture or inhuman and degrading treatment or punishment, including such treatment administered by private individuals (see Pretty, cited above, §§ 50 and 51). A positive obligation on the State to provide protection against inhuman or degrading treatment has been found to arise in a number of cases (see A. v. the United Kingdom, judgment of 23 September 1998, Reports 1998-VI, p. 2699, § 22; Z and Others v. the United Kingdom [GC], no. 29392/95, § 73, ECHR 2001-V; and M.C. v. Bulgaria, no. 39272/98, § 149, ECHR 2003-XII).
This protection calls for reasonable and effective measures, including with regard to children and other vulnerable individuals (see Okkalý v. Turkey, no. 52067/99, § 70, ECHR 2006-... (extracts), and paragraphs 24-27 above), in order to prevent ill-treatment of which the authorities were or ought to have been aware (see Mubilanzila Mayeka and Kaniki Mitunga v. Belgium, no. 13178/03, § 53, 12 October 2006).
97. Furthermore, Article 3 of the Convention gives rise to a positive obligation to conduct an official investigation (see Assenov and Others v. Bulgaria, judgment of 28 October 1998, Reports 1998-VIII, p. 3290, § 102). Such a positive obligation cannot be considered in principle to be limited solely to cases of ill-treatment by State agents (see M.C. v. Bulgaria, cited above, § 151).
256 Thus, the authorities have an obligation to take action as soon as an official complaint has been lodged. Even in the absence of an express complaint, an investigation should be undertaken if there are other sufficiently clear indications that torture or ill-treatment might have occurred. A requirement of promptness and reasonable expedition is implicit in this context. A prompt response by the authorities in investigating allegations of ill-treatment may generally be regarded as essential in maintaining public confidence in their maintenance of the rule of law and in preventing any appearance of collusion in or tolerance of unlawful acts. Tolerance by the authorities towards such acts cannot but undermine public confidence in the principle of lawfulness and the State’s maintenance of the rule of law (see Batý and Others v. Turkey, nos. 33097/96 and 57834/00, § 136, ECHR 2004-IV (extracts); Abdülsamet Yaman v. Turkey, no. 32446/96, § 60, 2 November 2004; and, mutatis mutandis, Paul and Audrey Edwards v. the United Kingdom, no. 46477/99, § 72, ECHR 2002-II).'
Directorate General of Human Rights, Council of Europe, 'The prohibition of torture - A guide to the implementation of Article 3 of the European Convention on Human Rights' http://echr.coe.int/NR/rdonlyres/0B190136-F756-4679-93EC-42EEBEAD50C3/0/DG2E NHRHAND062003.pdf p.16
'Treatment has been held by the Court to be “inhuman” because, inter alia, it was premeditated, was applied for hours at a stretch, and caused either actual bodily injury or intense physical and mental suffering.'
'Degrading treatment is that which is said to arouse in its victims feelings of fear, anguish and inferiority, capable of humiliating and debasing them. This has also been described as involving treatment such would lead to breaking down the physical or moral resistance of the victim, or as driving the victim to act against his will or conscience. In considering whether a punishment or treatment is “degrading” within the meaning of Article 3, regard should be had as to whether its object is to humiliate and debase the person concerned and whether, as far as the consequences are concerned, it adversely affected his or her personality in a manner incompatible with Article 3.' p. 39
'Failure to adequately respond to allegations of violations may in and of itself give rise to a separate and discrete violation of Article 3 on the part of the judicial authorities. This can arise because the procedural aspects of Article 3 have not been fulfilled, or because the actions or failures to act on the part of the judicial authorities have themselves caused such anguish to those seeking a remedy. Judicial authorities must have the tools at their disposal to offer and give effect to effective protection to persons from prohibitive behaviour. That means that the legal system needs to be adequately structured, and used, to provide effective protection. Gaps in the legal system will leave the judicial authorities exposed to potentially violating Article 3.' http://hudoc.echr.coe.int/sites/eng/pages/search.aspx?i=001-115621
CASE OF EL-MASRI v. THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA (Application no. 39630/09)
257
JUDGMENT
STRASBOURG
13 December 2012
'175. The UNHCHR submitted that the right to the truth was an autonomous right triggered by gross violations, as in the case of enforced disappearances. This right was also embodied in Article 13 and woven into Articles 2, 3 and 5 of the Convention. In enforced disappearances cases, the right to the truth was a particularly compelling norm, in view of the mystery surrounding the fate and whereabouts of the victim, irrespective of the eventual reappearance of the victim. Knowing the truth about gross human rights violations and serious violations of humanitarian law afforded victims, their relatives and close friends a measure of satisfaction. The right to the truth inured to the benefit of the direct victims of the violation, as well as to their relatives and to society at large. Rights holders were entitled to seek and obtain information on various issues, namely the identity of the perpetrators, the progress and results of an investigation and the circumstances and reasons for the perpetration of violations. On the other hand, the right to the truth placed comprehensive obligations on the State, including duties (1) to carry out an effective investigation; (2) to give victims and their relatives effective access to the investigative process; (3) to disclose all relevant information to the victims and the general public; and (4) to protect victims and witnesses from reprisals and threats. Lastly, the UNHCHR argued that the right to the truth was recognised in international law (the Convention on the Protection of All Persons from Enforced Disappearance) and the jurisprudence of the Inter-American Court and the African Commission on Human and Peoples’ Rights.
....
182. The Court reiterates that where an individual raises an arguable claim that he has suffered treatment infringing Article 3 at the hands of the police or other similar agents of the State, that provision, read in conjunction with the State’s general duty under Article 1 of the Convention to “secure to everyone within their jurisdiction the rights and freedoms defined in ... [the] Convention”, requires by implication that there should be an effective official investigation. Such investigation should be capable of leading to the identification and punishment of those responsible. Otherwise, the general legal prohibition of torture and inhuman and degrading treatment and punishment would, despite its fundamental importance, be ineffective in practice and it would be possible in some cases for agents of the State to abuse the rights of those within their control with virtual impunity (see Assenov and Others v. Bulgaria, 28 October 1998, § 102, Reports of Judgments and Decisions 1998-VIII; Corsacov v. Moldova, no. 18944/02, § 68, 4 April 2006; and Georgiy Bykov, cited above, § 60).
183. The investigation into serious allegations of ill-treatment must be both prompt and thorough. That means that the authorities must always make a serious attempt to find out what happened and should not rely on hasty or ill-founded conclusions to close their investigation or to use as the basis of their decisions (see Assenov and Others, cited above, § 103 and Bati and Others v. Turkey, nos. 33097/96 and 57834/00, § 136, ECHR 2004-IV (extracts)). They must take all reasonable steps available to them to secure the evidence
258 concerning the incident, including, inter alia, eyewitness testimony and forensic evidence (see Tanrikulu v. Turkey [GC], no. 23763/94, § 104, ECHR 1999-IV, and Gül v. Turkey, no. 22676/93, § 89, 14 December 2000). Any deficiency in the investigation which undermines its ability to establish the cause of injuries or the identity of the persons responsible will risk falling foul of this standard (see Boicenco v. Moldova, no. 41088/05, § 123, 11 July 2006).
184. Furthermore, the investigation should be independent from the executive (see Ogur v. Turkey [GC], no. 21594/93, §§ 91-92, ECHR 1999-III, and Mehmet Emin Yüksel v. Turkey, no. 40154/98, § 37, 20 July 2004). Independence of the investigation implies not only the absence of a hierarchical or institutional connection, but also independence in practical terms (see Ergi v. Turkey, 28 July 1998, §§ 83-84, Reports 1998-IV).
185. Lastly, the victim should be able to participate effectively in the investigation in one form or another (see, mutatis mutandis, Ogur, cited above, § 92; Ognyanova and Choban v. Bulgaria, no. 46317/99, § 107, 23 February 2006; Khadzhialiyev and Others v. Russia, no. 3013/04, § 106, 6 November 2008; Denis Vasilyev v. Russia, no. 32704/04, § 157, 17 December 2009; and Dedovskiy and Others v. Russia, no. 7178/03, § 92, ECHR 2008).'
Graham Senior-Milne
January 2014
259 Written evidence submitted by Peer Exchange
1 Introduction 1.1 We appreciate that we have missed the closing date to submit written evidence to the committee but thought we should at least try. Our contribution focuses on aspects of the following questions: • What are the respective roles of the police, health, education and social care professionals, and the third sector; and how can multi- agency co-operation be improved? • How can the systems for collecting and sharing information on FGM be improved? • How effective are existing efforts to raise awareness of FGM? • How can the available support and services be improved for women and girls in the UK who have suffered FGM?
2 Background
2.1 In May 2013 we were invited to pilot our Expert by Experience knowledge sharing platform with a group of 200+ people who attended a conference on Honour Violence. It was organised by the Tri Borough (City of Westminster, the London Borough of Hammersmith and Fulham and the Royal Borough of Kensington and Chelsea). Organisers of this annual event were struggling to find a solution to sustain the significant collaboration, commitment and enthusiasm generated on the day.
2.2 Following the success of the pilot we shared our learning with the Forced Marriage Unit (FMU) and subsequently became a member of their Strategic Partnership Board. In the intervening months we continued to engaged in discussion with professionals across the whole system and refine our knowledge sharing platform for this community’s use.
2.3 Stop Honour Violence will be one of the first sites that we are launching using the EbE knowledge sharing platform. It goes live in March. It is a protected, collaborative space explicitly for people working to prevent Honour Violence, Female Genital Mutilation and Forced Marriage. (It is not for the general public). Members will be able to:
• have exclusive access to experts and the SHV community to answer questions • share ideas, good practice, challenges and unintended outcomes which can then be developed into a unique knowledge resource • highlight gaps in service response and develop solutions using Smart Collaboration™ technology • identify and access quickly resource e.g. services, products, skills, and expertise • showcase their personal expertise and the activities and expertise of
260 their organisation
The Smart Collaboration™ technology we have developed will greatly assist the honour violence community to:
• increase participation and consultation among stakeholders across the whole system including social care, health and education. • address a wide range of coordination and consistency issues • improve data collection and analysis • become more collaborative and transparent in the way they interact with each other
The Stop Honour Violence Knowledge Sharing Platform is endorsed by the Forced Marriage Unit, a joint initiative between the Foreign and Commonwealth Office and the Home Office.
Our response to the following questions:
3. How can multi-agency co-operation be improved? 3.1 Our research indicates that multi-agency cooperation is hindered by a lack of: • protected, neutral, UK wide space in which professionals can freely engage, collaborate and positively challenge each other. • managed and moderated space that is offered as a service. • understanding across the whole system of the actual and perceived barriers organisations encounter in addressing FGM. • trust across the whole system. 3.2 Our research and experience indicates that the provision of managed space (as outlined in Section 2): • supports the sharing of good practice and develops a can do, solution focused mentality. • that is provided by an organisation which is not vying for position, status or monies with the organisations operating in this sector is enthusiastically welcomed. • quickly enhances understanding, leading to an improved level of trust.
4. How can the systems for collecting and sharing information on FGM be improved? 4.1 Our findings support that of other research i.e. the collecting and sharing of information on FGM is localised, spasmodic, unstructured and uncoordinated. 4.2 Our research and experience indicates that the provision of a managed space (as outlined in Section 2) offers a neutral environment in which to discuss, develop, design, pilot and analysis a range of information collection and sharing initiatives across the whole system.
261 5. How effective are existing efforts to raise awareness of FGM?
5.1 We would argue that efforts to raise awareness of FGM have never been as great or effective as they currently are. We believe however, these efforts are significantly reduced due to a lack of collaboration, coordination and confidence across the UK. 5.2 Expertise, experience and good practice is held in silos across the whole system. Voluntary, third and public sector organisations are vying for financial support. There is a London centric bias and limited opportunities for the opinions and experiences of smaller organisations to be regularly, quickly, easily and inexpensively sought. Research by academic institutes and individual organisations cannot be easily and quickly shared. At best this slows system wide learning, at worst some organisations, their stakeholders including services user do not benefit from the new learning. 5.3 Continual demands for improved and increased training are made within an unknown context. Unknown in terms of the range, level effectiveness and value for money (VFM) of existing provision. If this information existed or was developed it would provide an evidence base: • to promote, enhance or disband aspects of current training provision • to develop new content and models of delivery that are fit for purpose and provide VFM. 5.4 We believe existing and future efforts to raise awareness of FGM will be greatly enhanced through a neutral, protected space for professional that: • encourages, recognises and rewards engagement and collaboration across the whole system • offers equal opportunity to participate and be heard regardless of the organisations size and location • has supporting technology to collect, collate, analysis and report on the ideas, good practice, challenges and unintended outcomes which can then be developed into unique, proven knowledge resource • addresses a wide range of coordination and consistency issues to ensure best use is made of limited resource.
6 How can the available support and services be improved for women and girls in the UK who have suffered FGM? 6.1 Use a product such as Openstreetmap http://www.openstreetmap.org/about to simply, quickly map current whole systems support and services across the UK. This is then easily updated, rated and accessible to the public and professionals alike 6.2 Analysis of data from the mapping exercise and that collected through a neutral, collaborative platform to identify and address gaps in service provision and or performance. 6.3 Through the provision of, and incentivisation to use, a collaborative platform specifically for professionals across the whole system. Incentives should include visible recognition from the members/peers, links to Continuous Professional Development requirements, organisational performance monitoring and evaluation.
262
7 Declaration of interests 7.1 Stop Honour Violence Knowledge Sharing Platform • is owned by Peer Exchanged Ltd. A company registered in England and Wales. Company No: 07914266 • was funded, developed, piloted and launched by Peer Exchange Ltd. • is offered free to the Third and Voluntary sector • will be free to the public and private sector for a trial period before a nominal, monthly charge will be levied to cover operating cost.
End
263 Written evidence submitted by the Liberal Democrats for Seekers of Sanctuary
I am writing on behalf of Liberal Democrats for Seekers of Sanctuary about the situation with FGM and those seeking asylum in the UK. I am copying in Lynne Featherstone, too.
There are 2 issues that we are asking you to act upon please, and we would be interested to hear your views. 1. Women who are expected to perform FGM in their communities, and have fled to the UK as they are refusing to perform this barbaric act, and are in danger of their lives from the Elders who are insisting that it is carried out. Along with Baroness Hamwee, Lord Roberts, and party members we met a woman in this situation, and I have condensed her story below. Julian Huppert was at the event, but I am not sure if he actually met Maimura. 2. Women who have fled to the UK as their daughters are threatened with FGM, and it is the only way they can save them.
Both of the above categories have immense difficulty in going through our system to claim asylum. The understanding of Home Office Officials who deal with the cases is not what it could be, there is a culture of disbelief; lack of understanding of the situation in the home country where return to another part is just not safe; and insufficient knowledge and sensitivity around the whole issue.
Before making specific requests on actions, we are asking for your views on this, and the likelihood of you being able to implement necessary changes to inform and train Home Office Officials in issues around FGM, and look again at the criteria for assessing applications for leave to remain for those fleeing from having to perform FGM or be subjected to it.
The summary of the story of the woman we met is below. At the first meeting of Liberal Democrats for Seekers of Sanctuary, held jointly with Citizens UK, in September 2012, we met with those seeking sanctuary who had a story to tell our MPs, Peers, and members. The story of one has haunted us ever since. Maimura Gawo, is from Gambia. She is next in line to follow her mother and grandmother in the practice of female genital mutilation (FGM) – circumcision ‐ after her mother died prematurely. Her breaking point was when her 5 year old daughter had to be done. She just could not bring herself to do this to her daughter, so the rite was carried out by her mother. However she knew how much excruciating pain it caused, powders from plants in the forest were used to lessen the pain, but she knew that they did not work. She was refusing to carry out the rites, but as this was against tribal law, she made the difficult decision to leave the country, because it was the only way she to make sure she could not be forced to carry out FGM on the girls and young women of her village. While Maimuna is gone, the village elders have no one to do FGM, and a long list of girls are being saved from the torture of being blindfolded, and fully conscious, while their genitals are cut away. Maimuna has prevented FGM in the most effective way possible because she has removed the option of FGM in her village, and strengthened every woman who did not want FGM for themselves or their daughter. However, if sent back to The Gambia she would have to face the elders again, and no police or state body would protect a defiant woman who has gone against her elders – this would undermine the system. The elders are the source of authority in the villages and tribes, they settle the disputes, they are the law, and if they cannot force her to give in, they could kill her.
She has been through a very difficult process of trying to get leave to remain in this country, not being believed by Home Office officials. Surely listening properly to women in her situation, with a deeper understanding of the situation she has fled from and cannot return to, is not only our humanitarian duty, but a contribution to ending FGM in Africa ?
Suzanne Fletcher, Chair of LD4SOS.
264 Supplementary written evidence submitted by the NSPCC
Re: Home Affairs Select Committee Inquiry on Female Genital Mutilation
Thank you for the invitation to appear in front of the Committee on Tuesday 29th April to give evidence on Female Genital Mutilation. The Committee's efforts to highlight this crucial issue are extremely welcome. The Committee's inquiry can play an important role in shining a light not just on prosecutions, but also on how we can engage with communities where FGM occurs, and also emphasise the importance of providing therapeutic support for every girl that has undergone FGM.
I was very grateful to see the Committee's clear interest and appreciation for the NSPCC's dedicated 24-hour FGM helpline. We have a main helpline at the NSPCC which takes calls on all child abuse and neglect issues, and the FGM helpline is one of our bespoke helplines which launched in June 2013. The FGM helpline is for anyone concerned that a child's welfare is at risk because of FGM and is seeking advice, information or support. Calls to the helpline are primarily received from professionals, relatives, carers or other concerned individuals. From launching the helpline on 24th June 2013, through to 31st March 2013 we have received 198 contacts with 87 referrals made to the police.
As I am sure you are aware, the NSPCC also runs ChildLine. ChildLine is a private and confidential service for children and young people up to the age of nineteen. We have had further contact relating to FGM directly from young people and children through ChildLine. From April 2013 to December 2013, Childline dealt with 20 counselling sessions about FGM. Of these, 17 were with a child or young person who was contacting about a personal concern, and 3 were from a young person who had concerns about another child or young person being at risk of FGM.
We would like to invite you, and any other interested members of the Committee, to visit our dedicated FGM helpline. This would provide an opportunity to speak to counsellors and hear first-hand about the calls they receive. We would of course be delighted to welcome you to the helpline at any time. However, I wondered whether this may be particularly useful as the Committee compiles its report, or we could even facilitate the launch of the Committee's report from our helpline. Do let me know if you wish to discuss this further.
If there is any further information the NSPCC can provide that would be useful in compiling the Committee's final report, particularly information from the helpline or Childline, then please do not hesitate to get in touch.
We look forward to continuing to work with you to prevent this cruel form of child abuse.
Lisa Harker Director of Strategy, Policy and Evidence
NSPCC
1
265 Written evidence submitted by the London Safeguarding Children Board
Introduction The London Safeguarding Children Board provides strategic advice and support to London’s 32 Local Safeguarding Children Boards (LSCBs). The London Board is chaired by Cheryl Coppell (Chief Executive, London Borough of Havering), and its membership is made up of representatives from the London boroughs, the Metropolitan Police, health, probation and London independent, voluntary and community agencies. The London Board aims to respond to London agencies’ needs on specific issues, including: Providing a strategic safeguarding children policy lead for London; Promoting information sharing and collaboration in practice guidance and training for London agencies; Supporting research and initiatives to improve services and practice in London; Helping London agencies meet the challenges of national safeguarding children policy. The London Safeguarding Children Board also facilitates a number of professional networks and subgroups on specific issues.
The London Child Protection Procedures The London Safeguarding Children Board has responsibility for producing the London Child Protection Procedures (the Procedures), the first edition of which came out in 2002. The Procedures reflect extensive consultation with children’s services across London and address relevant areas of practice, legislation, national service standards and guidance as well as the latest research and practice-based evidence for securing the best possible outcomes for children and their families.
The Procedures set out how agencies and individuals should work together to safeguard and promote the welfare of children. Their target audience is professionals (including unqualified staff and volunteers) and front-line managers who have particular responsibilities for safeguarding and promoting the welfare of children, and operational and senior managers. The procedures are followed by all London agencies, groups and individuals when identifying, raising and responding to welfare concerns about children and are vital in ensuring that all London children receive a high standard and consistent response when there are concerns for their wellbeing.
266 The London agencies using these procedures include: All health services, including the London Ambulance Service; All other local authority services (including adults’ social care, housing, education, libraries, leisure and youth services and others); Children’s (and adults’) independent sector; Children’s (and adults’) services in the third sector; Children and Family Court Advisory and Support Service (CAFCASS); LA children’s social care; London Fire Brigade; Metropolitan Police Service; Probation service; Schools and further education services; Youth Offending Teams.
The London Child Protection Procedures - Safeguarding children at risk of abuse through female genital mutilation The Procedures address safeguarding children at risk of abuse through female genital mutilation. In addition, a Supplementary Procedure ‘Safeguarding children at risk of abuse through female genital mutilation’ was produced in 2006 and an FGM Resource Pack was produced in 2009. FGM is recognised in both the Procedures and the Resource Pack as a serious form of child abuse and a criminal offence. All guidance and resources have been developed in partnership with the Metropolitan Police, colleagues in health and specialist voluntary agencies such as FORWARD, the Foundation for Women's Health, Research and Development - an African Diaspora women's campaign and support charity.
The submission of the Metropolitan Police to the Home Affairs Select Committee [7.2.14] The Metropolitan Police, in paragraph 20 of their submission, raise concern that the Procedures [Supplementary Procedures: Safeguarding children at risk of abuse through female genital mutilation, paragraph 11.3.4] do not require children’s social care to automatically refer cases to the police where a girl has undergone FGM. However, it should be noted that at paragraph 11.3.1 the Procedures state that where a child has already undergone FGM a strategy meeting must be convened within two days and at paragraph 11.1.1 it specifies that this strategy meeting should involve representatives from the police. Hence, in all cases the Metropolitan
267 Police would be informed of a referral to children’s social care within less than 48 hours of that referral being received.
It should be noted that the Procedures and Resource Pack will be reviewed and updated in line with best practice over the next 6 months and that all members of the LSCB, including the Police, will be asked to participate in this review.
Mandatory Reporting
The LSCB would like further consideration to be given to the importance of ensuring that mandatory reporting to children’s social care of women who have themselves undergone FGM and have daughters, or are pregnant, is effective in reducing the risk of girls being subjected to FGM. In this regard the LSCB welcomes the two-year pilot, due to launch in June, in which Midwives will provide data to children’s social workers on all mothers who have undergone FGM themselves. This pilot, taking place in six London boroughs and managed by charity Children and Families Across Borders (CFAB), alongside the London Mayor’s Office for Policing and Crime, the Met Police, the Royal College of Midwives, NHS England and several other charities including the NSPCC, allows for a model of best practice to be developed which could then inform any legislative changes and the drafting of guidance provided to professionals working in this area.
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