Multi-Agency: Practice Guidelines: Female Genital Mutilation

Multi-Agency Practice Guidelines: Female Genital Mutilation Multi-Agency Practice Guidelines: Female Genital Mutilation 1 ACKNOWLEDGEMENTS We would like to thank the Royal College of Nursing, Leeds Teaching Hospital, London Safeguarding Children Board, Metropolitan Police Service and the Forced Marriage Unit from whose materials much of these guidelines were adapted. Details of these and other materials available can be found in Appendix E. We would also like to thank members of the FGM Forum for their contribution to these guidelines. COMMENTS OR SUGGESTIONS ON THE GUIDELINES? We would welcome any comments or suggestions about how to improve these guidelines. Please send your input to [email protected] 2 Multi-Agency Practice Guidelines: Female Genital Mutilation CONTENTS CHAPTER ONE THE PURPOSE OF THE GUIDELINES 1 1.1 AIMS 1 1.2 AUDIENCE 1 1.3 THE STATUS OF THE GUIDELINES 1 1.4 COVERAGE OF THE GUIDELINES 1 1.5 PRINCIPLES SUPPORTING THE GUIDELINES 2 CHAPTER TWO UNDERSTANDING THE ISSUES AROUND FGM 3 2.1 DEFINITION 3 2.2 TYPES OF FGM 3 2.3 UK LEGISLATION 3 2.4 FGM TAKING PLACE OVERSEAS 4 2.5 INTERNATIONAL PREVALENCE OF FGM 4 2.6 PREVALENCE OF FGM IN THE UK 6 2.7 NAMES FOR FGM 6 2.8 CULTURAL UNDERPINNINGS AND MOTIVES OF FGM 6 2.9 FGM PROCEDURE 7 2.10 CONSEQUENCES OF FGM 8 CHAPTER THREE IDENTIFYING GIRLS AND WOMEN AT RISK 11 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 15 4.1 DUTY TO SAFEGUARD CHILDREN AND PROTECT WOMEN AT RISK 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 19 4.8 FORCED MARRIAGE AND FGM 19 CHAPTER FIVE LEGAL INTERVENTIONS 21 5.1 POLICE PROTECTION 21 5.2 EMERGENCY PROTECTION ORDERS UNDER SECTION 44 OF THE CHILDREN ACT 1989 22 5.3 CARE ORDERS AND SUPERVISION ORDERS 23 5.4 INHERENT JURISDICTION 24 5.5 APPLICATIONS FOR WARDSHIP 25 5.6 REPATRIATION 25 CHAPTER SIX GUIDELINES FOR HEALTH PROFESSIONALS 27 6.1 HOW HEALTH PROFESSIONALS CAN MAKE A DIFFERENCE 27 6.2 GENERAL PRACTITIONERS AND PRACTICE NURSES 27 6.3 HEALTH VISITORS, SCHOOL AND COMMUNITY CHILDREN’S NURSES 28 6.4 MIDWIVES AND NEONATAL NURSES 28 6.5 OTHER HEALTHCARE PROFESSIONALS 29 6.6 CLINICAL ISSUES AND PROCEDURES 29 6.7 RE-SUTURING OR REINFIBULATION 29 6.8 COUNSELLING 30 CHAPTER SEVEN GUIDELINES FOR POLICE OFFICERS 31 7.1 HOW POLICE OFFICERS CAN MAKE A DIFFERENCE 31 7.2 EXAMPLE OF STANDARD OPERATING PROCEDURES 31 CHAPTER EIGHT GUIDELINES FOR CHILDREN’S SOCIAL CARE 35 8.1 HOW CHILDREN’S SOCIAL CARE CAN MAKE A DIFFERENCE 35 8.2 STRATEGY MEETING 35 8.3 STEPS WHEN A GIRL IS AT IMMEDIATE RISK OF FGM 36 8.4 STEPS WHEN A GIRL HAS ALREADY UNDERGONE FGM 36 CHAPTER NINE GUIDELINES FOR SCHOOLS, COLLEGES AND UNIVERSITIES 37 9. 1 HOW STAFF CAN MAKE A DIFFERENCE 37 9.2 WHAT TO DO WHEN YOU ARE CONCERNED THAT A STUDENT MAY BE AT RISK OF, OR HAS UNDERGONE, FGM 38 CHAPTER TEN 41 REDUCING THE PREVALENCE OF FGM 41 10.1 THE ROLE OF LOCAL SAFEGUARDING CHILDREN BOARDS 41 10.2 PROFESSIONAL LEARNING REQUIREMENTS 41 APPENDIX A GLOSSARY OF TERMS USED 43 APPENDIX B TERMS USED FOR FGM IN OTHER LANGUAGES 44 APPENDIX C FGM SPECIALIST HEALTH SERVICES IN ENGLAND AND WALES 45 APPENDIX D ORGANISATIONS WORKING ON ISSUES AROUND FGM 48 APPENDIX E MATERIALS AVAILABLE ABOUT FGM 49 CHAPTER ONE THE PURPOSE OF THE GUIDELINES 1.1 AIMS The information may also be relevant to non- This document seeks to provide advice and governmental organisations and voluntary support to frontline professionals who have organisations working directly with girls and responsibilities to safeguard children and women at risk of FGM, or dealing with its protect adults from the abuses associated with consequences. female genital mutilation (FGM). As it is unlikely 1.3 THE STATUS OF THE GUIDELINES that any single agency will be able to meet the multiple needs of someone affected by FGM, this These are practice guidelines and are designed document sets out a multi-agency response and to be educative and provide advice; they are not strategies to encourage agencies to cooperate a substitute for existing statutory guidance such and work together. as Working Together to Safeguard Children (2010) in England or Safeguarding Children: Working Together This guidance provides information on: Under the Children Act 2004 in Wales. identifying when a girl (including an unborn Existing strategic bodies should ensure that their girl) or young woman may be at risk of member agencies work effectively using existing being subjected to FGM and responding policies and procedures to tackle this issue. This appropriately to protect them; includes, but is not limited to, local authorities, local councils, Community Safety Partnerships, identifying when a girl or young woman has Local Strategic Partnerships, Local Safeguarding been subjected to FGM and responding Children Boards, Children’s Trusts, Multi-Agency appropriately to support them; and Risk Assessment Conferences, Local Criminal measures that can be implemented to Justice Boards, Local Family Justice Councils prevent and ultimately eradicate the and Multi-Agency Adult Protection Management practice of FGM. Committees. FGM is a form of child abuse and violence 1.4 COVERagE OF THE GUIDELINES against women and girls, and therefore These guidelines are designed for application in should be dealt with as part of existing England and Wales. child and adult protection structures, For more information about the Scottish policies and procedures. Government’s work to prevent and tackle FGM, visit 1.2 AUDIENCE www.scotland.gov.uk/Topics/People/Equality/ This guidance is designed for all frontline violence-women/MinorityEthnicIssuesPages/ professionals and volunteers within agencies FemaleGenitalMutilation that work to: For more information about the Northern safeguard children and young people from Ireland Executive’s work on domestic violence, abuse visit www.dhsspsni.gov.uk/domestic_violence protect adults from abuse. This includes, but is not limited to, NHS staff and other health professionals, police officers, children’s social care workers, and teachers and other educational professionals. Multi-Agency Practice Guidelines: Female Genital Mutilation 1 1.5 PRINCIPLES SUPPORTING THE All decisions or plans should be based GUIDELINES on good quality assessments (using, The following principles should be adopted by all for example, the Common Assessment agencies in relation to identifying and responding Framework) and be sensitive to the to girls (and unborn girls) and women at risk issues of race, culture, gender, religion and of, or who have experienced, FGM and their sexuality; and should avoid stigmatising the parent(s): girl or woman affected, and the practising community, as far as possible given the The safety and welfare of the child is other principles above. paramount. All agencies act in the interests of the rights of the child as stated in the UN Convention (1989). FGM is illegal in the UK (for more information, see Section 2.3). FGM is not a matter that can be left to be decided by personal preference – it is an extremely harmful practice. Professionals should not let fears of being branded ‘racist’ or ‘discriminatory’ weaken the protection required by vulnerable girls and women. Accessible, acceptable and sensitive health, education, police, social care and voluntary sector services must underpin interventions. It is acknowledged that some FGM- practising families do not see it as an act of abuse (for more information, see Section 2.8). However, FGM has severe significant physical and mental health consequences both in the short and long term (see Sections 2.10 and 2.11), and must not be excused, accepted or condoned. As an often embedded ‘cultural practice’, engagement with families and communities will be required to achieve a long-term abandonment and eradication of FGM. 2 Multi-Agency Practice Guidelines: Female Genital Mutilation CHAPTER two UNDERSTANDING THE ISSUES AROUND FGM SUMMARY It is illegal in the UK to subject a girl or woman to FGM or to assist a non-UK person to carry out FGM overseas. For the purpose of the criminal law in England, Wales and Northern Ireland, FGM is mutilation of the labia majora, labia minora or clitoris. FGM is prevalent in 28 African countries as well as in parts of the Middle East and Asia. It has been estimated that over 20,000 girls under the age of 15 are at high risk of FGM in the UK each year and that 66,000 women in the UK are living with the consequences, although its 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 belief that it is beneficial for the girl or woman. FGM constitutes a form of child abuse and violence against women and girls, and has severe short-term and long-term physical and psychological consequences. 2.1 DEFINITION Type 4 – Other: all other harmful FGM involves procedures that include the procedures to the female genitalia for partial or total removal of the external non-medical purposes, e.g. pricking, female genital organs for cultural or other piercing, incising, scraping and cauterising non-therapeutic reasons. The practice is the genital area. medically unnecessary, extremely painful and The age at which girls undergo FGM varies has serious health consequences, both at the enormously according to the community.

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