Protecting children from female genital mutilation (FGM)

Introduction

Female genital mutilation (FGM) is the partial or total removal of the external female genitalia for non-medical reasons. It's also known as female circumcision or cutting.

FGM is often performed by someone with no medical training who uses instruments such as a knife, scalpel, scissors, glass or razor blade. Children are rarely given anaesthetic or antiseptic treatment and are often forcibly restrained.

The age at which FGM is carried out varies. It may take place:

when a female baby is newborn
during childhood or adolescence
just before marriage
during pregnancy.

There are four main types of FGM:

Type 1 (clitoridectomy) – removing part or all of the clitoris.
Type 2 (excision) – removing part or all of the clitoris and cutting the inner and/or outer labia.
Type 3 (infibulation) – narrowing the vaginal opening.
Type 4 – other harmful procedures to the female genitals including pricking, piercing, cutting, scraping or burning (NHS Choices, 2021).

Labia elongation (also referred to as labia stretching or labia pulling) involves stretching the labia minora, sometimes using sticks, harnesses or weights (AFRUCA, 2016).

FGM is child abuse and is illegal in the UK. It can be extremely dangerous and can cause:

severe pain
shock
bleeding
infection such as tetanus, HIV and hepatitis B and C
organ damage
blood loss and infections
death in some cases.

Sometimes religious, social and cultural reasons are given to justify FGM, however it's a dangerous practice and can cause long-lasting health problems that continue throughout a child’s life, including:

incontinence or difficulties urinating
frequent or chronic vaginal, pelvic or urinary infections
menstrual problems
kidney damage and possible kidney failure
cysts and abscesses
pain during sex
infertility
complications during pregnancy and childbirth
emotional and mental health problems (NHS Choices, 2021).

Recognising

Recognising FGM

Risks and vulnerability factors

FGM can happen in the UK or abroad. Instances of FGM have been recorded in some African countries, areas of the Middle East, some Asian countries, the Americas, Europe and Australia (Department for Education (DfE), Department of Health and Social Care (DHSC) and Home Office, 2020).

The DfE, DHSC and Home Office have identified higher rates of FGM in certain countries, which may put children from these communities at higher risk. A list of these countries is provided in the multi-agency statutory guidance on female genital mutilation (DfE, DHSC and Home Office, 2020).

Children are also considered to be at higher risk if FGM has already been carried out on their mother, sister or a member of their extended family (DfE, DHSC and Home Office, 2020).

Signs and indicators

A child at immediate risk of FGM may ask you directly for help. But even if they don’t know what's going to happen, there may be other signs. You may become aware of:

a relative or ‘cutter’ visiting from abroad
a special occasion or ceremony to 'become a woman' or prepare for marriage
a female relative being cut – a sister, cousin, or an older female relative such as a mother or aunt
a family arranging a long holiday or visit to family overseas during the summer holidays
unexpected, repeated or prolonged absence from school
a girl struggling to keep up in school and the quality of her academic work declining
a child running away from or planning to leave home.

A child or woman who's had female genital mutilation (FGM) may:

have difficulty walking, standing or sitting
spend longer in the bathroom or toilet
appear withdrawn, anxious or depressed
display unusual behaviour after an absence from school or college
be particularly reluctant to have routine medical examinations
ask for help, but may not be explicit about the problem due to embarrassment or fear.

Assessing risk

The National FGM Centre has produced an assessment tool to help social workers dealing with situations where there are concerns about FGM to decide on the most appropriate action to take (National FGM Centre, 2021).

The Department of Health also provides guidance to help health professionals identify and assess the risk of female genital mutilation (FGM) for patients in their care and talk to patients and family members about FGM (Department of Health, 2017).

Responding

Responding to FGM

Providing support

If a child has already undergone FGM, they should be offered medical help and counselling. You should also take action to protect any other children in the family and to investigate possible risk to others in the community.

> Find out how to support children who are experiencing continence issues as a result of FGM

Reporting

If you think that a child may be at risk of FGM or if you suspect that FGM has already occurred, you must seek help and advice – even if the FGM didn’t happen recently.

If you think a child is in immediate danger, contact the police on 999. If you're worried about a child but they are not in immediate danger, you should share your concerns.

Follow your organisational child protection procedures. Organisations that work with children and families must have safeguarding policies and procedures in place.
Contact the FGM helpline on 0800 028 3550 or by emailing fgmhelp@nspcc.org.uk.
Apply for an FGM protection order. Anyone can apply on Gov.uk if they are concerned that someone is at risk of FGM.
Contact your local child protection services. Their contact details can be found on the website for the local authority the child lives in.
Contact the police.

Regulated health and social care professionals and teachers in England and Wales must report ‘known’ cases of FGM in those under age 18 to the police (Home Office, 2016).

Under Section 5 of the Criminal Law (Northern Ireland) Act 1967 it is an offence to fail to report a ‘relevant offence’ to the police. This includes:

knowing or believing that an offence has been committed
having information which could lead to the apprehension, prosecution or conviction of an offender.

This legislation covers offences against children and adults and includes offences related to FGM.

> See our information about recognising and responding to abuse

Prevention

Preventing FGM

People who work with children can help prevent FGM by:

challenging beliefs about FGM
educating communities about FGM
reporting any concerns.

You should give families information that is sensitive to their cultural or religious beliefs but also makes it clear that FGM is an illegal and dangerous practice.

It’s important for organisations to:

have written procedures that outline what to do in the event of a concern about FGM. This should be read and understood by all members of staff (whether paid or unpaid) and reviewed and updated annually
make sure all staff, whether paid or unpaid, understand what FGM is, know why it is dangerous and how to recognise the signs and indicators that a child is either at risk or has already undergone FGM
talk to children and families about FGM, to raise awareness and make sure children have the opportunity to speak out if they need to.

FGM protection orders

In England and Wales, the FGM protection order (FGMPO) is a way to protect actual or potential victims from FGM under civil law. Anyone can apply for an FGMPO (Gov.uk, 2016).

FGM protection orders are unique to each case and contain legally binding conditions, prohibitions and restrictions to protect a person at risk of FGM.

These may include:

confiscating passports or travel documents of the child at risk, family members and/or other named individuals to prevent girls from being taken abroad
ordering family members or other named individuals not to help another person to commit or attempt to commit an FGM offence, for example prohibiting them from bringing a "cutter" to the UK.

In an emergency, the court can make an order so that protection is in place immediately.

Breach of an FGM protection order is a criminal offence, carrying a sentence of up to five years in prison.

In Northern Ireland, Emergency Protection Orders (EPO) help protect children at risk of FGM (Department of Health, 2014). Anyone can apply for an EPO but in practice it is usually made by Health and Social Care (HSC) Children’s Services.

An EPO authorises the applicant to remove the child and take her to safe accommodation.

EPOs will only be granted to safeguard a child’s welfare.
EPOs last for up to eight days but may be extended on one occasion for up to seven days.

Legislation

Legislation, policy and guidance

It is illegal to carry out FGM in the UK. It is also a criminal offence for UK nationals or permanent UK residents to perform FGM overseas or take their child abroad to have FGM carried out. The maximum penalty for FGM is 14 years’ imprisonment.

Key legislation

In England, Northern Ireland and Wales, the Female Genital Mutilation Act 2003 sets out the law surrounding FGM. In Scotland it is the Prohibition of Female Genital Mutilation (Scotland) Act 2005.

Mandatory reporting

In England and Wales, regulated health and social care professionals and teachers have a mandatory duty to make a report to the police if:

they are informed by a child under the age of 18 that they have undergone FGM
they observe physical signs that an act of FGM may have been carried out on a child under the age of 18 (Section 74 Serious Crime Act 2015).

The Mandatory reporting of female genital mutilation - procedural information (Home Office, 2016) sets out this duty in further detail.

In Wales, professionals who identify cases of FGM must report to the local authority as well as the police (Female Genital Mutilation Act 2003 and Social Services and Well-being (Wales) Act 2014).

In Northern Ireland, it is an offence under Section 5 of the Criminal Law (Northern Ireland) Act 1967 to fail to report a ‘relevant offence’ to the police. This includes:

knowing or believing that an offence has been committed
having information which could lead to the apprehension, prosecution or conviction of an offender.

This legislation covers offences against children and adults and includes offences related to FGM.

Guidance

Each UK nation has its own guidance which sets out:

how to identify whether a child or young woman may be at risk of female genital mutilation (FGM)
how to identify a child or woman who has undergone FGM
how to protect those at risk and support those already affected
how to prevent and end FGM.

In England and Wales, the Multi-agency statutory guidance on female genital mutilation provides advice and support to professionals with the responsibility to safeguard and support those affected by FGM (Department for Education, Department of Health and Social Care and Home Office, 2020). This guidance should be considered alongside other statutory safeguarding guidance.

The Home Office has published a resource pack on female genital mutilation, which includes guidance and support materials for local authorities, professional services and voluntary organisations (Home Office, 2021).

The Department of Social Care has provided practical guidance on safeguarding women and girls at risk of FGM (Department of Health and Social Care, 2017).

In Northern Ireland professionals should follow the Multi-agency practice guidelines: Female genital mutilation (PDF) (Department of Health, 2014). The Department of Health and Safeguarding Board for Northern Ireland (SBNI) have also published guidance about safeguarding and risk assessment for FGM (Department of Health and SBNI, 2020).

In Scotland the guidance is Responding to female genital mutilation in Scotland: multi-agency guidance (PDF) (Scottish Government, 2017).

The Home Office has produced guidance for police and Border Force staff taking part in Operation Limelight, a multi-agency safeguarding operation at the UK border responding to FGM (Home Office, 2020).

Prosecution guidance

In England and Wales, the Crown Prosecution Service (CPS) provides Female genital mutilation prosecution guidance (CPS, 2019).

Policy

In September 2018, law enforcement agencies in the UK and USA signed an intelligence sharing agreement to help tackle FGM. Organisations including the National Police Chiefs’ Council (NPCC), the Metropolitan Police and Border Force in the UK; and the Federal Bureau of Investigation (FBI) and Department of Homeland Security in the USA agreed to share intelligence about travel patterns between the UK/USA and countries where children may be taken for FGM to be carried out.

This will help agencies to build their knowledge about FGM and learn from each other to tackle FGM more effectively (NPCC, 2018).

> Find out more about the intelligence sharing agreement

References and resources

AFRUCA (2016) Voices of the community: exploring type IV (labia elongation) female genital mutilation in the African community across Greater Manchester (PDF). London: AFRUCA.

Crown Prosecution Service (CPS) (2019) Female genital mutilation prosecution guidance. [Accessed 08/11/2021].

Department of Health (2014) Multi-agency practice guidelines: female genital mutilation (PDF). Belfast: Department of Health

Department of Health (2017) FGM safeguarding and risk assessment: quick guide for health professionals (PDF). London: Department of Health.

Department of Health and Safeguarding Board for Northern Ireland (SBNI) (2020) Female Genital Mutilation (FGM): safeguarding pathway and risk assessment. Belfast: SBNI.

Department of Health and Social Care (2017) Safeguarding women and girls at risk of FGM. [Accessed 08/11/2021].

Gov.uk (2016) Get a female genital mutilation (FGM) protection order (PDF). [Accessed 08/11/2021].

Department for Education, Department of Health and Social Care and Home Office (2020) Multi-agency statutory guidance on female genital mutilation. [London]: Home Office.

Home Office (2021) Female genital mutilation: resource pack. [Accessed 08/11/2021].

Home Office (2020) Operation Limelight: instructions to police and Border Force staff. [Accessed 08/11/2021].

Home Office (2016) Mandatory reporting of female genital mutilation – procedural information (PDF). London: Home Office.

National FGM Centre (2021) FGM assessment tool. [Accessed 08/11/2021].

NHS choices (2021) Female genital mutilation (FGM) London: NHS.

National Police Chiefs’ Council (NPCC) (2018) UK and US law enforcement sign an intelligence sharing agreement to tackle female genital mutilation. [Accessed 08/11/2021].

Scottish Government (2017) Responding to female genital mutilation in Scotland: multi-agency guidance (PDF). Edinburgh: Scottish Government.

Other resources

Watch our short film: Ending female genital mutilation.

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read about FGM on the Childline website. You can also download or order Childline posters and wallet cards.