Female genital mutilation Challenges for professionals 12-14 March 2016, Munich, Germany Dr. Comfort Momoh, religious obligation. This is not true, FGM is not in the 4. Empower frontline professionals; MBE Bible or in the Koran; it has nothing to do with 5. Identify girls at risk and refer them as part of FGM/Public Health religion. child safeguarding obligation; Specialist 6. Report cases of FGM; Guy's and St Thomas Most communities that practise FGM believe they are 7. Hold frontline professionals accountable; Foundation Trust doing the best for their daughters and they 8. Empower and support affected girls ang young London (UK) sometimes do not see FGM as a form of abuse. This women (both those at risk and survivors; and can be challenging to professionals and it is our legal 9. Implement awareness campaign. Comfort.Momoh@ duty to provide information to these communities and gstt.nhs.uk help to safeguard girls that might be at risk of FGM. FGM and the law "Female Genital Mutilation" was published by Radcliffe FGM is a crime in the UK and has been a specific Who performs FGM? Medical Press (2005) criminal offence since the Prohibition of Female Female Genital Mutilation (FGM) is recognised FGM is commonly performed by traditional birth Circumcision Act 1985 came into force on 16 worldwide as a fundamental violation of the human attendants, local women or men, or female family September 1985. The 1985 Act was replaced by the rights of girls and women. It reflects deep-rooted members. Such individuals do not have formal problems urinating, and later cysts, infections, Female Genital Mutilation Act 2003. It’s also illegal to inequality between the sexes and constitutes an medical training and usually perform FGM without as well as complications in childbirth and take abroad a British national or permanent resident extreme form of discrimination against women. anaesthesia or sterilisation. increased risk of newborn deaths. for FGM, or to help someone trying to do this. There is • More than 200 million girls and women alive up to 14 years in prison for carrying out FGM or FGM involves violation of rights of the children and It is not uncommon for those who perform FGM to cut today have been cut in 30 countries in Africa, the helping it to take place. violation of a person's right to health, security, and or damage more of the genital area than they intend. Middle East and Asia where FGM is concentrated1. physical integrity, the right to be free from torture and For example, an unskilled person may intend to • FGM is mostly carried out on young girls between The FGM protection orders and the Serious Crime Act cruel, inhuman, or degrading treatment, and the right perform Type 1 FGM, but do more damage to adjacent infancy and age 15. 2015 allows judges to remand people in custody, to life when the procedure results in death. organs resulting in Type 3 FGM. • FGM is a violation of the human rights of girls and order mandatory medical checks and instruct girls Furthermore, girls usually undergo the practice women (UN 2016). believed to be at risk of the practice to live at a without their informed consent, depriving them of the Dangers particular address so that authorities can check opportunity to make independent decision about their FGM can be potentially very dangerous for women's Role of professionals whether they have been subjected to it. Victims are bodies (Okeke 2012). health and psychological well-being. It can lead to Professionals have a pivotal role to play in identifying, also given lifelong anonymity. severe health problems, and in some cases, to death. sharing information and reporting cases of FGM. World Health Classification of FGM FGM causes gynaecological, urological, and obstetric Professionals must assess risk of FGM and treat it as a Key facts There are four main types of FGM. These are: problems in women. Indeed, FGM doubles the risk of child abuse-safeguarding and make referrals of under • FGM includes procedures that intentionally alter the mother's death in childbirth and increases the risk 18 years of age to the police-101. This is a legal or cause injury to the female genital organs for • Type 1, also known as "clitoridectomy," is the of the child being born dead by three to four times. requirement and responsibility. non-medical reasons. excision of the clitoral prepuce (or "hood") and • The procedure has no health benefits for girls and may also involve excision of all or part of the During and immediately after the FGM procedure, Risk assessment women. clitoris; women can experience significant pain and may Indicators that FGM may already have occurred • Procedures can cause severe bleeding and • Type 2 is the excision of the clitoris and may also suffer haemorrhage, shock, infection, urine retention, included absence from school or other activities with problems urinating, and later cysts, infections, as involve excision of all or part of the labia minora and injury to adjacent tissue, and ulceration of the noticeable behaviour change on return. Physical well as complications in childbirth and increased (the smaller, inner vaginal lips); genital region. In extreme cases, women may die indications include recurrent urinary tract infection, risk of newborn deaths. • Type 3, also known as "infibulation," involves from severe haemorrhaging. pain or frequenting toilet. • More than 200 million girls and women alive excision of part or all of the external genitalia and today have been cut in 30 countries in Africa, the the stitching or narrowing of the vaginal opening, Key facts If concern or worried that a girl might be at risk of Middle East and Asia where FGM is concentrated. and • FGM includes procedures that intentionally alter FGM, please call your local helpline. • FGM is mostly carried out on young girls between • Type 4 refers to all other genital procedures (WHO or cause injury to the female genital organs for infancy and age 15. 2014). non-medical reasons. Intercollegiate recommendations (2013) • FGM is a violation of the human rights of girls and • The procedure has no health benefits for girls 1. Treat FGM as a child abuse; women. FGM has no medical or health benefit and the and women. 2. Document and collect information; procedures are irreversible and their effects last a • Procedures can cause severe bleeding and 3. Share that information systematically; Convention and Charter lifetime, although the health impacts of FGM may be • Convention against Torture and other cruel, reduced in some cases. Inhuman or Degrading Treatment or Punishment. • The African Charter on the Rights and Welfare of Reasons behind FGM the Child, 1981 Communities that practise FGM put forward many • African Charter on Human and Peoples’ Right (the reasons and beliefs for the practice. Some of the most Banjul Charter) and it’s Protocol on the Rights of common beliefs about FGM are that it promotes Women in Africa. chastity, prevents promiscuity, promotes cleanliness • The convention on Elimination of All forms of and helps to secure a good marriage for one's Discrimination Against women 1979 – The Vienna daughter. Some people also believe that FGM is a Declaration and Programme of Action 1993 • The Beijing Declaration on Women’s Right 1995 and the United Nation Convention on the Right of European Association of Urology Nurses the Child 1989. EAUN in Munich: My experience Poster Sessions reflect the dynamic work of urology nurses 12-14 March 2016, Munich, Germany Mrs. Vitra Khati the presenters. I believe the idea of the poster session sheer enthusiasm the poster sessions generated King's College is to encourage urological nurses to become showed the scope of hard work and determination Hospital autonomous practitioners, build on our existing by the dedicated participants and organisers alike, Dept. of Urology service provision, challenge the need for change and of course without the interested audience the success London (UK) our existing thinking. To be inspired by our fellow of the session would not be possible. This simple colleagues both on a national and international level realisation I believe is a powerful tool in gaining in order to challenge practices and at the same time momentum for expansion in service provision and work towards consistency amongst urology nurse roles of urology nurse practitioners in our arena. practitioners and encourage forward thinking. [email protected] It was particularly impressive to observe the social networking these sessions provoked. Direct links were forged with speakers and audience participants, The 17th EAUN meeting was particularly interesting As an audience we appreciated the novice to expert exchanging of service provision and ideas were for me as it highlighted a range of interesting topics speakers, this in itself sums up the nature and genuinely given and received, contact links were EAUN Board and features that were applicable to my field of objective of this session. The variation in topics of made to ensure ideas were followed through and urological nursing and which enabled me to apply interest by participants highlighted the wide spectrum services could be forged in a similar fashion. The Chair Stefano Terzoni (IT) current practices. For the purpose of this article the in the roles of Nurse practitioners in different parts of Past Chair Lawrence Drudge- one session I felt had a significant impact on my the world - from the different approaches to Coates (UK) practice and thought process was the poster sessions. evaluating areas of practices, setting up and Board member Paula Allchorne (UK) The variation in topics showcased that as delivering new services, bringing forward new Board member Simon Borg (MT) autonomous practitioners in the field of urology we agendas and stimulating new ideas for the future in Board member Linda Söderkvist (SE) feel the need to explore these areas further.