FEMALE GENITAL MUTILATIONFGM AWARENESS A FORM OF HONOUR

FEMALE GENITAL MUTILATION(FGM) AWARENESS A FORM OF ‘HONOUR BASED VIOLENCE’

AIM & OBJECTIVES Aim: n To describe the subject of FGM and the issues around its use Objectives: By the end of the session the participants will be able to: n Describe the different forms of FGM & the implications it may have n Explain how to respond to incidents of FGM n Explain legislation & powers in relation to FGM.

WHAT IS FEMALE GENITAL MUTILATION?

DEFINITION OF FGM n All procedures which involve the partial or total removal of the external genitalia or injury to the female genital organs whether for cultural or any other nontherapeutic reasons The World Health Organisation (WHO)

n Mama tied a blindfold over my eyes. The next thing I felt my flesh was being cut away. I heard the blade sawing back and forth through my skin. The pain between my legs was so intense I wished I would die Waris Dirie, UNFPA Goodwill Ambassador and spokesperson on FGM.

Hadas' story

WHO IS AT RISK?

n 60, 000 girls under 15 are at risk of FGM in the UK n 137, 000 girls and women are living with the consequences of FGM in the UK n Over 125 million girls and women worldwide have undergone FGM n FGM is practiced in countries across Africa, parts of the Middle East, South East Asia and countries where migrants from FGM affected communities live. FORWARD

Source: UNICEF (July 2013), global databases based on data from Multiple Indicator Cluster Survey, Demographic and Health Survey and other national surveys, 1997– 2012

UK COMMUNITIES AT RISK n n n n Kenyan Somali Sudanese Sierra Leonean Egyptian Nigerian Eritrean. Non-African communities that practise FGM include Yemeni, Afghani, Kurdish, Indonesian and Pakistani Home Office Leaflet – FGM the facts

Beliefs and attitudes leading to the practice of FGM n Tradition n Culture n Family honour n Social acceptance and standing within the community, bringing status and respect to the girl n Perceived religious obligations n Chastity as a requirement of eligibility for marriage n Curbing a woman’s sexuality n Rite of passage/part of becoming a woman.

Beliefs and attitudes leading to the practice of FGM (continued. . ) n Hygiene/belief that it makes a woman ‘clean’ n Belief that it makes sexual relations safer and more pleasurable for the man n Social conditioning (women having poor body image if FGM is not done/redone after childbirth) n Misinformed beliefs regarding fertility and childbirth, including that it makes childbirth safer n Superstition and myth. Authorised Professional Practice – College of Policing

TYPES

NORMAL FEMALE GENITAL ANATOMY © 2015 Bawso Ltd. Confidential and Proprietary

TYPE 1 CLITORIDECTOMY n Partial or total removal of the clitoris and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris) n Also known as Sunna (among some Arab speakers), Bolokoli (Sierra Leone) .

FGM TYPE 1 © 2015 Bawso Ltd. Confidential and Proprietary

TYPE 2 - EXCISION n Involves removal of the clitoris and partial or total removal of the vaginal lips n Most common operation and is practised throughout Africa, Asia, the Middle East. n Up to 80% of all cases.

FGM TYPE 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). © 2015 Bawso Ltd. Confidential and Proprietary

TYPE 3 - INFIBULATION n Involves excision plus the removal of the labia majora and the sealing of the two sides, through stitching or natural fusion of scar tissue n A small opening to permit urination and passage of menstrual blood is left n Artificial opening sometimes no larger than the head of a match n 15% of all procedures n As many as 90% of women from Somalia, Djibouti and Northern Sudan.

FGM TYPE 3 Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner and sometimes outer labia, with or without removal of © 2015 Bawso Ltd. Confidential and the clitoris. Proprietary

TYPE 4 – UNCLASSIFIED Includes all other operations on the female genitalia for non medical purposes including: n Piercing of the clitoris n Vulval tattoos n Cauterisation by burning of clitoris n Introduction of corrosive substance into the vagina to cause bleeding or herbs into the vagina with the aim of tightening or narrowing the vagina.

HOW IS FGM CARRIED OUT? n Often performed with basic cutting instruments n Little or no anaesthetic n Long term physical and emotional complications including flashbacks n Permanent damage.

HEALTH IMPLICATIONS § § § § SHORT TERM Shock Haemorrhage Trauma Infection Urinary Retention Death Possible transmission of HIV § § § § § LONG TERM Implantation cysts Keloid scar formation Dysuria Surgery to achieve intercourse Dyspareuria Psycho – social PID/infertility Dysmenorrhoea Vaginal Infection Complications in pregnancy and birth

Indicators FGM may be about to take place n The family come from a community that is known to practise FGM n Parents state they will take the child out of the country for a prolonged period n A child may talk about a long holiday to a country where the practice is prevalent n A child may confide that she is to have a “special procedure” or celebration.

LEGISLATION

FEMALE GENITAL MUTILATION ACT 2003 It is an offence to: n Perform FGM in the UK or take a girl abroad to be subjected to FGM n Assist (aid, abet, counsel or procure) the carrying out of FGM in the UK or abroad; n Assist a girl to carry out FGM on herself in the UK or abroad n Assist from the UK a non-UK person to carry out FGM outside the UK on a UK national or permanent UK resident. n For someone in the UK to aid, abet, counsel or procure FGM outside of UK that is carried out by a person who isn’t a UK national or resident.

Serious Crimes Act 2015 n Extend extra-territorial jurisdiction for FGM, n Provide anonymity for victims of FGM, n Create a new offence of failure to protect a girl from FGM, n Introduce FGM protection orders, n Introduces a mandatory reporting duty requiring regulated health and social care professionals to report known cases of FGM in under 18 s to the police n Confers on the secretary of state a power to issue statutory guidance on FGM

FGM PROTECTION ORDER n Came in to force on 17 th July 2015 n Section 73 of The Serious Crime Act 2015, inserts a new section 5 A into the Female Genital Mutilation Act 2003 n Based on the existing rules for Forced Marriage Protection Orders n Breach of an FGMPO carries a sentence of up to 5 years.

Reporting and referrals

Clinical pathway n n This Clinical Pathway should be completed every time a new case of FGM is identified or suspected in women/girls of any age This can be found on the Female Genital Mutilation (FGM) page on the CAV web intranet. Part of the clinical pathway includes FGM identification. Do not carry out a genital examination unless this is already part of your role. For adults please refer on to the GP who can complete an onward referral to the gynaecology department or for children at risk a formal diagnosis will be sought as part of the subsequent multi -agency response. Please complete as much of the pathway as possible and then email to safeguarding. referrals@wales. nhs. uk or fax to 02921 832000

Mandatory reporting of FGM n n n If FGM is confirmed in a girl under 18 years of age (either on examination or because the patient or parent says it has been done), reporting to the police is mandatory and this must be within 1 month of confirmation. Professional who identified the FGM calls the police on 101 to make a report. You will have to provide: The girl’s name, date of birth and her address ¨ Your contact details ¨ The contact details of your Safeguarding lead ¨ n n Record all decisions, actions and the police incident number Child protection referral must ALSO be completed.

Safeguarding n Child protection referral required; Female child under 18 with ‘known’ or suspected FGM ¨ Mother has FGM and a female child or is pregnant. ¨ Disclosure from family member or child of indicators for future FGM. ¨ n Adult at risk ¨ If a woman is at risk of FGM and is considered to be an adult at risk (vulnerable), consider adult at risk referral (VA 1).

Content of referral n n n n Country of origin Status in UK (i. e asylum seeker) Type of FGM (if known) Other members of family with FGM Approximate age FGM performed and where. Parents beliefs and views regarding FGM. Include wider family (if known) Use of interpreter Evidence of discussion regarding FGM legislation and parents reaction.

WHAT’S IN PLACE IN WALES n FGM Safeguarding Protocol n FGM Strategic Group n FGM Training Group n CPS/NPCC Protocol n Government Statement opposing FGM https: //www. gov. uk/government/publications/statement-opposing -female-genital-mutilation n College of Policing APP – https: //www. app. college. police. uk/app-content/majorinvestigation-and-public-protection/female-genitalmutilation/#the-practice-of-fgm

HELPLINES n UHB safeguarding team 02921 832001 n BAWSO helpline: 0800 731 8147 (24 -hour) n NSPCC’s FGM helpline: 0800 028 3550 (24 -hour), Email: fgmhelp@nspcc. org. uk n Live fear free Helpline: 0808 2000 247 (24 -hour) n Child. Line 24 -hour Helpline for children: 0800 1111

Thank you Any questions?