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Multi-Agency Practice Guidelines: Female Genital Mutilation

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Multi-Agency Practice Guidelines: Female Genital Mutilation MULTI-AGENCY PRACTICE GUIDELINES: FEMALE GENITAL MUTILATION Contents CHAPTER ONE PURPOSE OF THE GUIDELINES 1.1 AIMS 1 1.2 AUDIENCE 1 1.3 THE STATUS OF THE GUIDELINES 2 1.4 COVERAGE OF THE GUIDELINES 2 1.5 PRINCIPLES SUPPORTING THE GUIDELINES 2 CHAPTER TWO UNDERSTANDING THE ISSUES AROUND FGM 2.1 DEFINITION 4 2.2 TYPES OF FGM 4 2.3 UK LEGISLATION 5 2.4 FGM TAKING PLACE OVERSEAS 5 2.5 INTERNATIONAL PREVALENCE OF FGM 6 2.6 PREVALENCE OF FGM IN THE UK 6 2.7 NAMES FOR FGM 6 2.8 CULTURAL UNDERPINNINGS AND MOTIVES OF FGM 7 2.9 FGM PROCEDURE 8 2.10 CONSEQUENCES OF FGM 8 CHAPTER THREE IDENTIFYING GIRLS AND WOMEN AT RISK 3.1 SPECIFIC FACTORS THAT MAY HEIGHTEN A GIRL’S OR WOMAN’S RISK OF BEING AFFECTED BY FGM 11 3.2 INDICATIONS THAT FGM MAY BE ABOUT TO TAKE PLACE SOON 11 3.3 INDICATIONS THAT FGM MAY HAVE ALREADY TAKEN PLACE 12 CHAPTER FOUR GOOD PRACTICE TO FOLLOW IN ALL CASES 4.1 DUTY TO SAFEGUARD AND PROTECT 14 4.2 TALKING ABOUT FGM 15 4.3 THINGS TO BE AWARE OF IN DEALING WITH CASES OF FGM 18 4.4 MEDICAL EXAMINATIONS 18 4.5 MAKING ENQUIRIES 19 4.6 DISCLOSURE AND CONFIDENTIALITY 19 4.7 A VICTIM-CENTRED APPROACH 20 4.8 FORCED MARRIAGE AND FGM 20 CHAPTER FIVE LEGAL INTERVENTIONS 5.1 POLICE PROTECTION 21 5.2 EMERGENCY PROTECTION ORDERS 23 5.3 CARE ORDERS AND SUPERVISION ORDERS 24 5.4 INHERENT JURISDICTION 26 5.5 APPLICATIONS FOR WARDSHIP 27 5.6 REPATRIATION 27 CHAPTER SIX GUIDELINES FOR HEALTH PROFESSIONALS 6.1 HOW HEALTH PROFESSIONALS CAN MAKE A DIFFERENCE 29 6.2 GENERAL PRACTITIONERS AND PRACTICE NURSES 30 6.3 HEALTH VISITORS, SCHOOL NURSES, COMMUNITY CHILDREN’S NURSES AND COMMUNITY PAEDIATRICIANS 30 6.4 OBSTETRICIANS, MIDWIVES AND NEONATAL STAFF 31 6.5 OTHER HEALTHCARE PROFESSIONALS 32 6.6 CLINICAL ISSUES AND PROCEDURES 32 6.7 RE-SUTURING OR REINFIBULATION 33 6.8 COUNSELLING 33 CHAPTER SEVEN GUIDELINES FOR THE POLICE SERVICE 7.1 HOW POLICE OFFICERS CAN MAKE A DIFFERENCE 35 7.2 STEPS WHEN A GIRL MAY BE AT RISK OF FGM 35 7.3 STEPS WHEN A GIRL HAS ALREADY UNDERGONE FGM 37 7.3 CONDUCTING INTERVIEWS ABOUT FGM 38 7.3 MEDICAL EXAMINATIONS 38 CHAPTER EIGHT GUIDELINES FOR HEALTH AND SOCIAL CARE CHILDREN’S SERVICES 8.1 HOW HSC CHILDREN’S SERVICES CAN MAKE A DIFFERENCE 40 8.2 STRATEGY MEETING 40 8.3 STEPS WHEN A GIRL IS AT IMMEDIATE RISK OF FGM 41 8.4 STEPS WHEN A GIRL HAS ALREADY UNDERGONE FGM 41 CHAPTER NINE GUIDELINES FOR SCHOOLS, COLLEGES AND UNIVERSITIES 9. 1 HOW STAFF CAN MAKE A DIFFERENCE 42 9.2 WHAT TO DO WHEN YOU ARE CONCERNED THAT A STUDENT MAY BE AT RISK OF, OR HAS UNDERGONE, FGM 43 9.3 WHAT TO DO WHEN A STUDENT STOPS ATTENDING SCHOOL 45 CHAPTER TEN REDUCING THE PREVALENCE OF FGM 10.1 ROLE OF SAFEGUARDING BOARD FOR NORTHERN IRELAND 46 10.2 PROFESSIONAL LEARNING REQUIREMENTS 46 10.3 WORKING WITH COMMUNITIES TO ELIMINATE FGM 47 APPENDIX A: GLOSSARY OF TERMS USED APPENDIX B: TERMS USED FOR FGM IN OTHER LANGUAGES APPENDIX C: RELEVANT ORGANISATIONS APPENDIX D: MATERIALS AVAILABLE ABOUT FGM APPENDIX E: HOSPITALS AND CLINICS IN THE UK OFFERING SPECIALIST FEMALE GENITAL MUTILATION HEALTH SERVICES CHAPTER ONE PURPOSE OF THE GUIDELINES 1.1 Aims This document seeks to provide FGM is a form of child abuse and advice and support to frontline violence against women and girls professionals who are responsible and should, therefore, be dealt for safeguarding children and with as part of existing child and protecting adults from the abuses adult safeguarding structures, associated with female genital policies and procedures. mutilation (“FGM”). As it is unlikely that any single agency will be able to meet the multiple needs of 1.2 Audience someone affected by FGM, this document sets out a multi-agency The guidelines in this document response and strategies to are aimed at all frontline encourage agencies to co-operate professionals and volunteers within and work together. agencies that work to: This document sets out: • safeguard children and young people from abuse; • how to identify a girl or (including an unborn girl) or • safeguard adults from young woman who may be abuse. at risk of being subjected to FGM and how to respond This includes, but is not limited to, appropriately to protect her; Health and Social Care (“HSC”) staff and other health • how to identify when a girl professionals, police officers, staff or young woman has been in HSC Children’s Services and subjected to FGM and how teachers and other educational to respond appropriately to professionals. The information may support her; and also be relevant to non- governmental organisations and • measures that can be voluntary organisations working implemented to prevent, directly with girls and women at and ultimately eradicate, the risk of FGM, or dealing with its practice of FGM. consequences. 1 1.3 The status of the 1.5 Principles supporting guidelines the Guidelines These guidelines are practice The following principles should be guidelines and are designed to be adopted by all agencies in relation educative and provide advice. They to identifying and responding to are not a substitute for existing girls (and unborn girls) and women statutory guidance, such as Co- at risk of, or who have experienced, operating to Safeguard Children FGM and their parent(s): (2003), the Regional Child Protection Policy and Procedures • The safety and welfare of or Safeguarding Vulnerable Adults the child is paramount. – Regional Adult Protection Policy • Regard should be had to the and Procedural Guidance. United Nations Convention on the Rights of the Child Existing bodies and organisations (1989). should ensure that their agencies • FGM is illegal in the UK (for work effectively using existing more information, see policies and procedures to tackle Section 2.3). this issue. This includes, but is not • FGM is not a matter that can limited to, the Police Service of be left to be decided by Northern Ireland (“PSNI”), the HSC personal preference – it is Board, the Public Health Agency, illegal, abusive and an HSC Trusts and the Safeguarding extremely harmful practice. Board for Northern Ireland Professionals should not let (“SBNI”). fears of being branded ‘racist’ or ‘discriminatory’ 1.4 Coverage of the weaken the protection Guidelines afforded to vulnerable girls and women. These guidelines, which are • Accessible, acceptable and designed for application in Northern sensitive health, education, Ireland, have been adapted from police, social care and the guidelines which apply in voluntary sector services England and Wales.1 must underpin interventions. • Some FGM practising families do not see it as an act of abuse (for more information, see Section 2.8). However, FGM has 1 severe and significant http://www.gov.uk/government/uploads/ physical and mental health system/uploads/attachment_data/file/9785 7/FGM.pdf consequences, both in the short and long term (see For information about the Scottish Section 2.10), and must not Government’s work to prevent and tackle be excused, accepted or FGM visit: condoned. http://www.scotland.gov.uk/Topics/People/E quality/violence- women/MinorityEthnicIssuesPages/Female 2 GenitalMutilation • Engagement with families and communities will be required to achieve the long- term abandonment and eradication of FGM. 3 CHAPTER TWO UNDERSTANDING THE ISSUES AROUND FGM Summary • It is illegal in the UK to subject a girl or young woman to FGM or to assist a non-UK person to carry out FGM overseas. For the purposes of the criminal law in Northern Ireland, FGM is the mutilation of the labia majora, labia minora or the clitoris. • FGM is prevalent in 28 African countries, as well as parts of the Middle East and Asia. • It has been estimated that, in the UK, over 20,000 girls under the age of 15 are at risk of FGM each year and that 66,000 women are living with the consequences of FGM, although the true extent is unknown, due to the hidden nature of the crime. • FGM is practised by families for a variety of complex reasons, but often in the mistaken belief that it is for the benefit of the girl or woman. • FGM constitutes a form of child abuse and violence against children and women and has severe long-term and short-term physical and psychological consequences. 2.1 Definition FGM involves procedures that very rare cases, only the include the partial or total removal prepuce (the fold of skin of the external female genital surrounding the clitoris). organs for cultural or other non- therapeutic reasons. The practice • Type 2 – Excision: partial or is medically unnecessary, total removal of the clitoris extremely painful and has serious and the labia minora, with or health consequences, both at the without excision of the labia time when the mutilation is carried majora (the labia are the out and in later life. ‘lips’ that surround the vagina). 2.2 Types of FGM • Type 3 – Infibulation: FGM has been classified by the narrowing of the vaginal World Health Organization into opening through the four types: creation of a covering seal. The seal is formed by cutting and repositioning the • Type 1 – Clitoridectomy: inner, or outer, labia, with or partial or total removal of without removal of the the clitoris (a small, clitoris. sensitive and erectile part of the female genitals) and, in 4 grounds or an operation performed • Type 4 – Other: all other by a registered medical practitioner harmful procedures to the or midwife or a person undergoing female genitalia for non- training with a view to becoming a medical purposes, e.g.
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