Female Genital Mutilation / Cutting
Between April 2016 and March 2017 there were 1,065 newly recorded women and girls presenting at
Health settings in London,where FGM was identified or a procedure of FGM was undertaken.
NHS Digital FGM Annual Report 2016-2017
What is FGM?
FGM is a form of violence against women and girls (VAWG). It comprises of all procedures involving partial or total removal of the external female genitalia for non-medical reasons. It may be carried out at any time in a girls life, from baby to womanhood. It can be seen as a pathway to womanhood and can also be a condition of marriage. Some communities believe that if a girl has not had it done she is deemed unhealthy, unclean, or unworthy. Parents can have very strong beliefs, genuinely thinking they are doing the right thing for their daughter, and in communities where all females have the procedure it can seem normal, then making it very difficult for girls to challenge this tradition. However, not every mother who has had FGM will put their daughter(s) through the same procedure. Each case should be assessed carefully and sensitively.
It is sometimes also known as female circumcision. Other local terms are: Tahoor, Absum, Halalays, Khitan, Ibi, Sunna, Gudnii, Bondo, Kutairi. It is important to let the female refer to the term she understands it to be called. FGM is sometimes incorrectly believed to be an Islamic practice. This is not the case and the Islamic Shari’a Council, the Muslim College and the Muslim Council of Britain (MCB) have condemned the practice of FGM. The majority of cases of FGM are thought to take place between the ages of 5 and 8 and therefore girls within that age bracket are at a higher risk.
Mandatory Reporting Duty - What are ‘known cases?
Known cases are those where either a girl informs the person that an act of FGM – however described – has been carried out on her, or where the person observes physical signs on a girl appearing to show that an act of FGM has been carried out and the person has no reason to believe that the act was, or was part of, a surgical operation within section 1(2)(a) or (b) of the FGM Act 2003. The duty applies to all regulated professionals working within health or social care, and teachers. There is mandatory requirement to report to police cases of ‘visually identified’ or ‘verbally disclosed’ cases of FGM in girls under 18. The mandatory reporting does not apply to suspected cases or where a child might be ‘at risk’ of FGM. The mandatory reporting is for ‘known’ cases only.
It is Illegal
In the UK, anyone found guilty of an FGM offence or of helping somebody commit one, faces up to 14 years in prison, a fine, or both, regardless of where in the world the FGM takes place. Anyone found guilty of failing to protect a girl from risk of FGM faces up to 7 years in prison, a fine, or both. Lewisham has secured 1 FGM Protection Order.
Recognising Signs & Symptoms of Possible FGM Cases
A girl may;
- Say an older female relative is coming especially to see her.
- Say that she is being taken "home" for a special visit to become a woman (right of passage).
- become withdrawn following this "holiday" and/or there may be a change in her behavior.
- Run away from home, or start truanting from school.
- Have difficulty standing or sitting.
- Spend longer in the toilet than usual; because of bleeding and/or infection.
- Have frequent vaginal, urinal, or pelvic infections.
- Blood born infections, including Hepatitis B & C, and HIV.
- She may be reluctant to undergo any medical examinations.
- May ask for help, but not be explicit about the problem due to fear or embarrassment
- Develop emotional and mental health problems.
- Self harm, or be showing signs of child abuse.
Long Term Health Effects
Many girls and women are not aware of the lifetime effects FGM can have on them; with difficulty in child birth (sometimes ending in death), infertility, sexually difficulties, vaginal infections, painful periods, cysts and abscesses, and difficulty controlling her bladder. This is a procedure that cannot be reversed. FGM also involves a long term emotional impact including, anxiety, depression, and post traumatic stress disorder.
FGM is classified into four categories:
- Clitoridectomy: partial or total removal of the clitoris and, in very rare cases, only the prepuce
- Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora
- 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
- Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area
Language & Image Guide - Please refer to the current language and image guidance to use when talking to survivors of FGM.
The following are terms used by different nationality's to describe FGM. You will need to consider that a survivor may not recognise FGM or Cutting to describe what they have experienced.
- Egypt: Thara / Khitan / Khifad
- Ethopia: Megrez / Absum
- Eritrea: Mekhnishab
- Kenya: Kutairi / Kutairi was ichana
- Nigeria: Ibi / Ugwu / Sumna
- Sierra Leone: Sunna / Bondo / Bondo Sonde
- Somalia: Gudiniin / Halalays / Qodiin
- Sudan: Khifad / Tahoor
- CHAD: Bagtne / Gadja
- Guinea-Bissau: Fanadu di Mindjer / Fanadu di Omi
- Gambia: Niaka / Kuyango / Musolula Karoola
Procedure in Lewisham
The LSCB Partnership has endorsed a local FGM Guidance to assist you with your responsibilities.
At-Risk Cases of FGM
Situations whereby the female child is at risk of FGM being performed, suspected of being performed, or suspected of having been performed, normal safeguarding procedures and existing pathways would apply. You should consult with your appointed safeguarding lead and you should report it to MASH on 020 8314 6660 and email firstname.lastname@example.org.
An FGM Protection Order offer a legal means to protect and safeguard victims and potential victims of FGM. Please see the Fact Sheet for more information.
Reporting Known Cases in Lewisham
In London the only reporting gateway for mandatory reports is via 101. You should also inform MASH and your appointed safeguarding lead of your report.
The duty applies to all regulated professionals working within health or social care, and teachers. There is mandatory requirement to report to police cases of ‘visually identified’ or ‘verbally disclosed’ cases of FGM in girls under 18. The mandatory reporting does not apply to suspected cases, or where another person (including the mother) discloses that FGM has taken place, or where a child might be ‘at risk’ of FGM. The mandatory reporting is for ‘known’ cases only, and this can be any girl of any nationality.
Home Office Mandatory Reporting Procedural Guidance
Government Safeguarding women and girls at risk of FGM: FGM Safeguarding Pathway, Quick Guide for Health Professionals and templates.
Multi-Agency Statutory Guidance FGM
Support is Available for Girls and Women at Risk
You can obtain a Statement Opposing Female Genital Mutilation for girls and women. It is in a variety of languages on the GOV.UK website. Girls and Women can also contact;
- Athena VAWG Service on 0800 112 4052, email email@example.com, website www.refuge.org.uk/Athena
- African Advocacy Foundation on 020 8698 447, website http://www.africadvocacy.org/
- NSPCC FGM Helpline on 0800 028 3550, email firstname.lastname@example.org
- FGM Every Bodys Biz website provides advice, support and a forum to hear the voice of the girl/woman. You can also obtain up-to-date information on FGM Health Specialists and organisations working on FGM, http://fgm-every-bodys-biz.co.uk/
- If a girl or woman has been taken abroad phone the Foreign & Commonwealth Office immediately on 020 7008 1500.
Specialist FGM Clinics for Survivors of FGM
African Well Women’s Clinic
Guy’s & St Thomas’ Hospital, 8th Floor, c/o Antenatal Clinic, Lambeth Palace Road, London SE1 7EH
Tel: 020 7188 6872
Open Monday-Friday, 9am to 4pm.
Contact: Confort Momoh MBE, FGM / Public Health Specialist 07956 542 576
Action African Well Women Centre
Self Referral for free confidential services
Contact: Julia Albert – Midwife or Hayat Arteh – Health Advocate
Tel: 020 8383 8761 or 07956 001 065
or 07730 970 738
Manor Gardens Clinic
The project works with volunteer FGM Community Champions, delivers training, provide workshops and 1:2:1 support through the Dahlia project (Specialist therapeutic service for women who have undergone FGM).
For further information on FGM we would encourage all professionals to view the excellent Home Office training package on FGM which can be found at: www.fgmelearning.co.uk/
Useful Links & Guidance:
NHS England Posters & Guidance
National FGM Centre
FGM Map by Country & Origin and their Practice
FGM Health Passport- Statement opposing FGM guidance in different languages.
Links to information about FGM Orders:-
National FGM Centre
Courts of Justice - Family Procedure Rules
What to do if you are worried about the Safety of a child – professionals
Female Genital Mutilation - An Overview (leaflet)