Female Genital Mutilation

• A female child is born to a woman who has undergone FGM or whose older sibling or cousin has undergone FGM;
• The child's father comes from a community known to practise FGM;
• The family indicate that there are strong levels of influence held by elders and/or elders are involved in bringing up female children;
• A woman/family believe FGM is integral to cultural or religious identity;
• A girl/family has limited level of integration within the UK community;
• The girl talks about a 'special procedure/ceremony' that is going to take place or attending a special occasion to 'become a woman';
• Parents have limited access to information about FGM and do not know about the harmful effects of FGM or UK law;
• A parent or family member expresses concern that FGM may be carried out on the girl;
• A family is not engaging with professionals (health, education or other);
• A family is already known to social care in relation to other safeguarding issues;
• A girl requests help from a teacher or another adult because she is aware or suspects that she is at immediate risk of FGM;
• A girl talks about FGM in conversation, for example, a girl may tell other children about it - it is important to take into account the context of the discussion;
• Sections are missing from a girl's Red book.

It is also important to consider whether FGM may have already taken place, for example if:

• A girl asks for help;
• A girl confides that FGM has taken place;
• A mother/family member discloses that female child has had FGM;
• A girl has difficulty walking, sitting or standing or looks uncomfortable;
• A girl finds it hard to sit still for long periods of time, and this was not a problem previously;
• A girl spends longer than normal in the bathroom or toilet due to difficulties urinating;
• A girl spends long periods of time away from a classroom during the day with bladder or menstrual problems;
• A girl has frequent urinary, menstrual or stomach problems;
• A girl avoids physical exercise or requires to be excused from physical education (PE) lessons without a GP's letter;
• There are prolonged or repeated absences from school or college;
• A girl displays increased emotional and psychological needs, for example withdrawal or depression, or significant change in behaviour;
• A girl is reluctant to undergo any medical examinations;
• A girl asks for help, but is not being explicit about the problem; and/or
• A girl talks about pain or discomfort between her legs.

Remember: this is not an exhaustive list of indicators.

Where there are concerns that FGM has taken place, the foster carer should inform their supervising social worker.

As soon as a girl is identified as at risk of FGM, information should be shared with other agencies (in accordance with local information sharing protocols and Information Sharing: Advice for Safeguarding Practitioners.

All concerns identified and actions agreed should be noted in the child's record.

The level of safeguarding intervention needed will depend on how imminent the risk of harm is. An appropriate course of action should be decided on a case-by-case basis, following a risk assessment, with expert input from all relevant agencies. A victim centred approach should be taken, based on a clear understanding of the needs and views of the child.

If, following Referral to Children's Social Care there is cause to believe that the child has suffered or is likely to suffer Significant Harm, a Section 47 Enquiry will be carried out in conjunction with the Police. A strategy discussion/meeting will be held, and this should include relevant health professionals and, if the child is of school age, a school representative.

If the only risk indicator is that a girl's mother has undergone FGM, Referral to Children's Social Care may not be appropriate, but other local multi- agency arrangements may be relevant. In such cases, monitoring is important to ensure that agencies respond appropriately if circumstances change and other risk factors arise. Where there is a specific risk, the case should be referred to Children's Social Care.

When a girl is at imminent risk, legal intervention should be considered, including an FGM Protection Order (FGMPO).

Professionals should remember that FGM can be carried out at any age, so identifying at birth that a girl is at risk of FGM means that safeguarding measures adopted may need to remain in place for a number of years over the course of her childhood.

In this situation, professionals should always take opportunities to discuss and understand changes to the girl's/family's circumstances.

Where there are concerns that FGM has taken place

Children's Social Care will liaise with Paediatric services where it is believed that FGM has already taken place to ensure that a Medical Assessment takes place and the girl receives the care and support she needs. Enquiries will be made about other female family members who may need to be safeguarded from harm. Criminal investigations into the perpetrators can also be commenced (see Section 6, Law in England, Wales and Northern Ireland).

National FGM Support Clinics have been established to offer a range of support services for women over 18 who have undergone FGM. Support for girls under 18 is available from a specialist paediatric service at University College London Hospitals (UCLH). UCLH can be contacted by email at UCLH.paediatricsafeguarding@nhs.net.

Support for children, young people and families is also available from the NSPCC.

Training should be available to enable you as a foster carer to support a child who has been subjected to FGM. Training on FGM could include the following:

• An overview of FGM (what it is, when and where it is performed);
• The UK law on FGM and child protection;
• The potential consequences of FGM;
• What to do when FGM is suspected or has been performed; and
• The role of different professionals and the importance of multi-agency working.

See also: E-learning for all professionals is available at Virtual College website, Female Genital Mutilation: Recognising and Preventing FGM.

Health Education England offer e-learning, free to access by health and social care professionals.

Depending on the degree of mutilation, FGM can have a number of short-term health implications:

• Severe pain and shock;
• Wound infections;
• Urine retention;
• Injury to adjacent tissues;
• haemorrhaging;
• Genital swelling;
• Death.

Long-term implications can include:

• Genital scarring;
• Genital cysts and keloid scar formation;
• Recurrent urinary tract infections and difficulties in passing urine;
• Possible increased risk of blood infections such as hepatitis B and HIV;
• Pain during sex, lack of pleasurable sensation and impaired sexual function;
• Psychological concerns such as anxiety, flashbacks and post traumatic stress disorder;
• Difficulties with menstruation (periods);
• Complications in pregnancy or childbirth (including prolonged labour, bleeding or tears during childbirth, increased risk of caesarean section); and
• Increased risk of stillbirth and death of child during or just after birth.

In addition to these health consequences there are considerable psycho-sexual, psychological and social consequences of FGM.

1. An offence of failing to protect a girl from the risk of FGM - A person is liable if they are "responsible" for a girl at the time when an offence is committed. This covers both someone who has "parental responsibility" for the girl and has "frequent contact" with her, as well as any adult who has assumed responsibility for caring for the girl in the "manner of a parent". This could be for example family members, with whom she was staying during the school holidays;
2. Female Genital Mutilation Protection Orders ("FGMPO"). An FGMPO is a civil order which may be made for the purposes of protecting a girl against the commission of an FGM offence or protecting a girl against whom an FGM offence has taken place. Breaching an order carries a penalty of up to 5 years in prison. The terms of the order can be flexible and the court can include whatever terms it considers necessary and appropriate to protect the girl or woman including to protect a girl from being taken abroad or to order the surrender of passports;
3. Allowing for the lifelong anonymity of victims of FGM – prohibiting the publication of any information that could lead to the identification of the victim. Publication covers all aspects of media including social media;
4. Extra-territorial jurisdiction over offences of FGM committed abroad by UK nationals and those habitually (as well as permanently) resident in the UK;
5. Mandatory reporting which requires specified professionals to report known cases of FGM in under 18s to the police.

Please note: in Scotland, FGM is illegal under the Prohibition of Female Genital Mutilation (Scotland) Act 2005.

See also: Making an Application for an FGM Protection Order (FGMPO) - Flowchart.