FGM Awareness Presentation RESTRICTED What is FGM comprises

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FGM Awareness Presentation RESTRICTED

FGM Awareness Presentation RESTRICTED

What is FGM comprises all procedures involving partial or total removal of the external

What is 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 RESTRICTED

Types of FGM 1. Clitoridectomy: partial or total removal of the clitoris (a small,

Types of FGM 1. 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). RESTRICTED

Types of FGM (cont. ) 3. Infibulation: narrowing of the vaginal opening through the

Types of FGM (cont. ) 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 nonmedical purposes, e. g. pricking, piercing, incising, scraping and cauterizing the genital area. RESTRICTED

How FGM is performed • • • RESTRICTED Traditional birth attendants/cutters Anesthetic rarely used

How FGM is performed • • • RESTRICTED Traditional birth attendants/cutters Anesthetic rarely used Special knives/razors/piece of glass Wound held together with thorns In type 3 legs are bound together until wound is healed

Short term implications • • • RESTRICTED Hemorrhage Severe pain and shock Urine retention

Short term implications • • • RESTRICTED Hemorrhage Severe pain and shock Urine retention Injury to adjacent tissues Fracture/dislocation Death due to severe bleeding/shock/septicemia

Long term complications • • • RESTRICTED Difficulty in passing urine/UTI/kidney damage Painful and

Long term complications • • • RESTRICTED Difficulty in passing urine/UTI/kidney damage Painful and difficult periods Sexual dysfunction/infertility Acute/chronic pelvic infection which can lead to infertility Cyst/scar formation

Obstetric consequences • • • RESTRICTED Difficulty with vaginal examination Scarring and stricture of

Obstetric consequences • • • RESTRICTED Difficulty with vaginal examination Scarring and stricture of vaginal canal Possible obstructed labour Psychological trauma, flashbacks Foetal asphyxia Perineal tears –scar tissue , fistulae

Psychological and Mental Health • • • RESTRICTED Flashback during labour /PTSD Trauma Mental

Psychological and Mental Health • • • RESTRICTED Flashback during labour /PTSD Trauma Mental health problems Relationship issues Anger/regret/feeling of betrayal by own parents

Reasons given for practicing FGM • • • • It brings status and respect

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 infant It rids the family of bad luck RESTRICTED

Warning signs • This procedure often takes place in the summer, as the recovery

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 PSHE • A visiting female elder from the country of origin • Being taken on a long holiday to the family’s country of origin • Talk about a ‘special’ event or procedure to ‘become a woman’ RESTRICTED

Where is FGM practiced • It is practiced in over 28 African countries such

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 Africa • UK, Europe, USA, Canada, Australia and New Zealand • In 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. RESTRICTED

Post-FGM Symptoms • • • Difficulty walking, sitting or standing Spend longer than normal

Post-FGM Symptoms • • • Difficulty walking, sitting or standing Spend longer than normal in the bathroom or toilet Unusual behaviour after a lengthy absence Reluctance to undergo normal medical examinations Asking 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. RESTRICTED

Religion Islam forbids FGM. Although FGM is practiced by secular communities, it is most

Religion 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. RESTRICTED

UK: Statistics for FGM • • • 66, 000 girls aged 0 -14 were

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 Wales in 2011 Source: NHS & City University and Equality Now RESTRICTED

The Law 1. Prohibition of Female Circumcision act 1985 (penalty 5 Years imprisonment) 2.

The Law 1. Prohibition of Female Circumcision act 1985 (penalty 5 Years imprisonment) 2. Female Genital Mutilation Act 2003 • Penalty 14 years imprisonment • Anyone involved in taking girl outside of the UK to have FGM carried out • Perform FGM in UK • Counsel a girl to carry out FGM on herself RESTRICTED

Serious Crime Act 2015 • • • RESTRICTED Provides lifelong anonymity for victims FGM

Serious Crime Act 2015 • • • RESTRICTED Provides lifelong anonymity for victims FGM Protection Order Mandatory reporting to police for under 18’s

Mandatory Reporting From October 2015, section 74 of the Serious Crime Act 2015, will

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. RESTRICTED

Safeguarding girls and women from FGM • FGM is recognised internationally as a violation

Safeguarding girls and women from FGM • FGM 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. RESTRICTED

Safeguarding girls and women from FGM There are 3 circumstances which require intervention: 1.

Safeguarding girls and women from FGM There are 3 circumstances which require intervention: 1. Where a child is identified at risk 2. Where a child has been abused through FGM 3. Where a prospective mother has undergone FGM RESTRICTED

How to respond • • RESTRICTED Ask directly if they were cut At risk:

How to respond • • RESTRICTED Ask directly if they were cut At risk: under 18 yrs 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.

The Waltham Forest Approach • Harmful Practices Pilot Ø Educating school aged children Ø

The Waltham Forest Approach • Harmful Practices Pilot Ø Educating school aged children Ø Raising awareness of the safeguarding responsibilities Ø Our approach is early intervention to prevent girls from getting mutilated Ø Psychological support for victims Ø Referral for deinfibulation or related health concerns such as infertility, incontinence • Establishing a robust engagement and enforcement plan for all communities affected by FGM as a part of our Violence Against Women and Girls Strategy RESTRICTED

Making a Referral Multi Agency Safeguarding Hub (MASH) Juniper House, 221 Hoe Street, London

Making a Referral Multi Agency Safeguarding Hub (MASH) Juniper House, 221 Hoe Street, London E 17 9 PH Tel: 020 8496 2310 (Monday to Thursday 9 am – 5. 15 pm and Friday 9 am – 5 pm) Tel: 020 8496 3000 (Out of Hours) Email: cscreferrals@walthamforest. gov. uk Fax – 0208 496 1320 Guidance and referral form: http: //www. walthamforest. gov. uk/Pages/Service. Child/mash-professionals. aspx RESTRICTED

Contacts Hibo Wardere, FGM Community Mediator Hibo. Wardere@walthamforest. gov. uk, 07970 965285 Mamta Sagar,

Contacts Hibo Wardere, FGM Community Mediator Hibo. Wardere@walthamforest. gov. uk, 07970 965285 Mamta Sagar, FGM Senior Practitioner Mamta. Sagar@walthamforest. gov. uk, 0208 496 6947 Sarah Kurylowicz, Senior Programme Manager (VAWG) Sarah. Kurylowicz@walthamforest. gov. uk, 07581752327 RESTRICTED