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FGM Awareness Presentation

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What is FGM

FGM comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. It has no health benefits and harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and hence interferes with the natural function of girls’ and women’s bodies.

HM Government: FGM Multi Agency Guidance

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Clitoridectomy

: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).

2. Excision: partial or total removal of the clitoris and the labia

minora, with or without excision of the labia majora (the labia are "the lips" that surround the vagina). Types of FGM

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3

. Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris.

4.

Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area. Types of FGM (cont.)

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How FGM is performed

Traditional birth attendants/cutters

Anesthetic rarely used Special knives/razors/piece of glass

Wound held together with thornsIn type 3 legs are bound together until wound is healed

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Short term implications

Hemorrhage

Severe pain and shock Urine retention

Injury to adjacent tissues Fracture/dislocationDeath due to severe bleeding/shock/septicemia

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Long term complications

Difficulty in passing urine/UTI/kidney damage

Painful and difficult periods Sexual dysfunction/infertility

Acute/chronic pelvic infection which can lead to infertilityCyst/scar formation

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Obstetric consequences

Difficulty with vaginal examination

Scarring and stricture of vaginal canal Possible obstructed l

abourPsychological trauma, flashbacks Foetal asphyxiaPerineal tears –scar tissue , fistulae

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Psychological and Mental Health

Flashback during

labour /PTSDTrauma

Mental health problems Relationship issues Anger/regret/feeling of betrayal by own parents

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Reasons given for practicing FGM

It brings status and respect to the girl.

It preserves a girl’s virginity/chastity. It is part of being a woman.

It is a rite of passage. It gives a girl social acceptance, especially for marriage. It upholds the family honor. It cleanses and purifies the girl. It gives the girl and her family a sense of belonging to the community. It fulfills a religious requirement believed to exist. It perpetuates a custom/tradition. It helps girls and women to be clean and hygienic. It is aesthetically desirable. It is mistakenly believed to make childbirth safer for the infantIt rids the family of bad luck

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Warning signs

This procedure often takes place in the summer, as the recovery period after FGM can be 6 to 9 weeks.

Mother or sister who has undergone FGM

Girls who are withdrawn from PSHEA visiting female elder from the country of originBeing taken on a long holiday to the family’s country of originTalk about a ‘special’ event or procedure to ‘become a woman’

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Where is FGM practiced

It is practiced in over 28 African countries such as Somalia, Kenya, Ethiopia, Sierra Leone, Sudan, Egypt, Nigeria, Eritrea,

Middle East, Yemen, Syria, North Iraq and other Kurdish areas Indonesia, Malaysia , Papua New Guinea

Bhora Muslims in Pakistan, India and East AfricaUK, Europe, USA, Canada, Australia and New ZealandIn the UK, FGM tends to occur in areas with larger populations of communities who practise FGM, such as first-generation immigrants, refugees and asylum seekers.

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Post-FGM Symptoms

D

ifficulty walking, sitting or standing

Spend longer than normal in the bathroom or toiletUnusual behaviour after a lengthy absenceReluctance to undergo normal medical examinationsAsking for help, but may not be explicit about the problem due to embarrassment or fear or may mention that they are collecting information for their friend.

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Religion

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Islam forbids

FGM. Although FGM is practiced by secular communities, it is most often claimed to be carried out in accordance with religious beliefs. However, FGM predates Christianity, Islam and Judaism, and the Bible, Koran, Torah and other religious texts do not advocate or justify FGM.

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UK: Statistics for FGM

66,000

girls aged 0-14 were born in England to mothers who had FGM.Approximately 137,000

women aged 15-49 and approximately 24,000 women aged 50+ are living with consequences of FGM.65,000 girls aged under 13 are at risk of FGM in UK.The first ever recorded figures for female genital mutilation (FGM) show that between April 2015 and March 2016 there were 5,702 new cases in England.Combining the figures for the three age groups, an estimated 170,000 women and girls affected by FGM, born in countries where FGM is practiced, were permanently resident in England and Wales in 2011 Source: NHS & City University and Equality Now

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The Law

Prohibition of Female Circumcision act 1985 (penalty 5

Years imprisonment)Female Genital Mutilation Act 2003

Penalty 14 years imprisonmentAnyone involved in taking girl outside of the UK to have FGM carried outPerform FGM in UKCounsel a girl to carry out FGM on herself

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Serious Crime Act 2015

Provides lifelong anonymity for victims

FGM Protection Order

Mandatory reporting to police for under 18’s

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Mandatory Reporting

From October 2015, section

74 of the Serious Crime Act 2015, will place a statutory duty upon

all Regulated Professionals, Health, Social Care and Teachers, to report to the police where they discover (either through disclosure by the victim or visual evidence) that FGM appears to have been carried out on a girl under 18. Those failing to report such cases will face disciplinary sanctions. These cases must be referred to police (via the local CAIT team or by calling 101). Immediate reporting is required if FGM has been performed recently, and in historical cases, reporting must take place within one month.

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Safeguarding girls

and women from

FGMFGM is recognised internationally as a violation of the human rights of girls and women.

FGM constitutes child abuse and causes physical, psychological and sexual harm which is life long.FGM is illegal in the UK.

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Safeguarding girls and women from FGM

There are 3 circumstances which require intervention:

Where a child is identified at riskWhere a child has been abused through FGMWhere a prospective mother has undergone FGM

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How to respond

Ask directly if they were cut

At risk: under 18yrs needs to be reported to MASH (give as much detail as possible)DO NOT wait to make a referral to MASH/Out of Hours if you think that a child is at immediate

risk, call 999. Mandatory reporting: where a child has been cut cases must be referred to police (via the local CAIT team or by calling 101). Immediate reporting is required if FGM has been performed recently, and in historical cases, reporting must take place within one month.

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The Waltham Forest Approach

Harmful

Practices PilotEducating

school aged childrenRaising awareness of the safeguarding responsibilitiesOur approach is early intervention to prevent girls from getting mutilated Psychological support for victimsReferral for deinfibulation or related health concerns such as infertility, incontinenceEstablishing a robust engagement and enforcement plan for all communities affected by FGM as a part of our Violence Against Women and Girls Strategy

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Making a Referral

Multi

Agency Safeguarding Hub (MASH)Juniper House, 221 Hoe Street, London E17 9PHTel

: 020 8496 2310 (Monday to Thursday 9am – 5.15pm and Friday 9am – 5pm)Tel: 020 8496 3000 (Out of Hours)Email: cscreferrals@walthamforest.gov.ukFax – 0208 496 1320Guidance and referral form: http://www.walthamforest.gov.uk/Pages/ServiceChild/mash-professionals.aspx

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Contacts

Hibo Wardere, FGM Community

MediatorHibo.Wardere@walthamforest.gov.uk,

07970 965285Mamta Sagar, FGM Senior PractitionerMamta.Sagar@walthamforest.gov.uk, 0208 496 6947Sarah Kurylowicz, Senior Programme Manager (VAWG)Sarah.Kurylowicz@walthamforest.gov.uk, 07581752327

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