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Definition

Female genital mutilation (FGM) is a collective term for procedures, which include the removal of part or all of the external female genitalia for cultural or other non-therapeutic reasons. The practice is medically unnecessary, extremely painful and has serious health consequences, both at the time when the mutilation is carried out and in later life. The procedure is typically performed on girls aged between 4 and 13, but in some cases it is performed on new-born infants or on young women before marriage or pregnancy.

FGM has been a criminal offence in the U.K. since the Prohibition of Female Circumcision Act 1985 was passed. This legislation has not been extended to Jersey. However, the Female Genital Mutilation Act 2003 replaced the 1985 Act and makes it an offence for the first time for UK nationals or permanent UK residents to carry out FGM abroad, or to aid, abet, counsel or procure the carrying out of FGM abroad, even in countries where the practice is legal.

The 1989 Convention on the Rights of the Child ratified in Jersey protects against all forms of mental and physical violence and maltreatment (art 19.1); to freedom from torture or cruel, inhuman or degrading treatment (art 37a), and requires States to take all effective and appropriate measures to abolish traditional practices prejudicial to the health of children (art 24.3).

See also United Nations Population Fund – Promoting Gender Equality – FAQ - FGM.

The rights of women and girls are enshrined by various universal and regional instruments including the Universal Declaration of Human Rights, the United Nations Convention on the Elimination of all Forms of Discrimination Against women, the Convention on the Rights of the Child, the African Charter on Human and Peoples’ Rights and Protocol to the African Charter on Human and Peoples’ Rights on the rights of women in Africa. All these documents highlight the right for girls and women to live free from gender discrimination, free from torture, to live in dignity and with bodily integrity.

Click here to access the Gov.uk website for Female Genital Mutilation.


Indicators

These indicators are not exhaustive and whilst the factors detailed below may be an indication that a child is facing FGM, it should not be assumed that is the case simply on the basis of someone presenting with one or more of these warning signs. These warning signs may indicate other types of abuse such as forced marriage or sexual abuse that will also require a multi-agency response.

The following are some signs that the child may be at risk of FGM:

  • A female child is born to a woman who has undergone FGM or whose older sibling or cousin has undergone FGM;

  • The family belongs to a community in which FGM is practised or have a limited level of integration within the UK/Channel Islands and the family indicate that there are strong levels of influence held by elders and/or elders are involved in bringing up female children;

  • If a female family elder is present, particularly when she is visiting from a country of origin and taking a more active/influential role in the family;

  • The practice is common in parts of Africa, Asia and in some Arab Countries. It is practiced among communities in : Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d'Ivoire, Democratic Republic of Congo, Djibouti, Egypt, Ethiopia, Eritrea, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Uganda;

  • FGM is also practiced among certain ethnic groups in a number of Asian countries (India, Indonesia, Malaysia, Pakistan); among some groups in the Arabian Peninsula (in Oman, United Arab Emirates, Yemen); Iraq; occupied Palestinian territories and among certain immigrant communities in Europe, Australia, Canada and the United States;

  • The family makes preparations for the child to take a holiday, e.g. arranging vaccinations, planning an absence from school;

  • The child talks about a ‘special procedure/ceremony’ that is going to take place;

  • An awareness by a midwife or obstetrician that the procedure has already been carried out on a mother, prompting concern for any daughters, girls or young women in the family.
  • Repeated failure to attend or engage with health and welfare services;
  • Where a girl from a practising community is withdrawn from Sex and Relationship Education; they may be at risk from their parents wishing to keep them uniformed about their body and rights.

Consider whether any other indicators exist that FGM may have or has already taken place, for example:

  1. The child has changed in behaviour after a prolonged absence from school; or

  2. The child has health problems, particularly bladder or menstrual problems;
  3. The child has difficulty walking, sitting or standing and may appear to be uncomfortable.

The Children’s Services team will liaise with the Paediatric services where it is believed that FGM has already taken place to ensure that a Medical Assessment takes place.

It should be remembered that this will have lifelong consequences, and can be highly dangerous at the time of the procedure and directly afterwards.


Protection and Action to be Taken

Where concerns about the welfare and safety of a child or young person have come to light in relation to FGM, a MASH enquiry should be made. (See MASH Enquiries Procedure).

Alerting the girl or woman’s family to the fact that she is disclosing information about FGM may place her at increased risk of harm.

It should not be assumed that families from practising communities will want their girls and women to undergo FGM.

Children’s Services will undertake an assessment, and jointly with the Police, will undertake a Article 42 Enquiry if they have reason to believe that a child is likely to suffer or has suffered FGM. A Strategy Discussion/ Meeting should include the relevant Health professionals and, if the child is of school age, the relevant school representative.

Where a child has been identified as having suffered, or being likely to suffer, significant harm, it may not always be appropriate to remove the child from an otherwise loving family environment. Parents and carers may genuinely believe that it is in the girl’s best interest to conform to their prevailing custom. Professionals should work in a sensitive manner with families to explain the legal position around FGM. The families will need to understand that FGM and re-infibulation (the process of resealing the vagina after childbirth) is illegal and that if they are insistent upon carrying out the practice, the health visitor and Children’s Services must be informed that a female child may be at risk of significant harm. Interpretation services should be used if English is not spoken or well understood and the interpreter should not be an individual who is known to the family.

Where a child appears to be in immediate danger of mutilation, legal advice should be sought, making it clear to the family that they will be breaking the law if they arrange for the child to have the procedure. There is no equivalent legislation in Jersey to the UK Female Genital Mutilation Act 2003.

All nurses and doctor in Jersey are legally required to be registered under local legislation and through their governing bodies will have access to guidance on FGM.  Registration in Jersey is dependent on nurses and midwives being registered with the Nursing and Midwifery Council (NMC) and doctors holding General Medical Council (GMC) registration with a licence to practise.

NMC guidance on FGM

GMC guidance on male circumcision

GMC guidance on FGM


Issues

Where is FGM Practised?

As a result of immigration and refugee movements, FGM is now being practiced by ethnic minority populations in other parts of the world, such as USA, Canada, Europe, Australia and New Zealand. FORWARD estimates that as many as 6,500 girls are at risk of FGM within the UK every year.

There is no Biblical or Koranic justification for FGM and religious leaders from all faiths have spoken out against the practice.

Consequences of FGM

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

  1. Severe pain and shock;
  2. Infection;
  3. Urine retention;
  4. Injury to adjacent tissues;
  5. Immediate fatal haemorrhaging.

Long-term implications can entail:

  1. Extensive damage of the external reproductive system;
  2. Uterus, vaginal and pelvic infections;
  3. Cysts and neuromas;
  4. Increased risk of Vesico Vaginal Fistula;
  5. Complications in pregnancy and child birth;
  6. Psychological damage;
  7. Sexual dysfunction;
  8. Difficulties in menstruation.

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

Justifications of FGM

The justifications given for the practise are multiple and reflect the ideological and historical situation of the societies in which it has developed. Reasons include:

  1. Custom and tradition;
  2. Religion, in the mistaken belief that it is a religious requirement;
  3. Preservation of virginity/chastity;
  4. Social acceptance, especially for marriage. It can be a prerequisite of inheritance;
  5. Hygiene and cleanliness;
  6. Increasing sexual pleasure for the male;
  7. Family honour;
  8. A sense of belonging to the group and conversely the fear of social exclusion;
  9. Enhancing fertility.

FGM is a complex and sensitive issue that requires professionals to approach the subject carefully. An accredited female interpreter may be required. Any interpreter should ideally be trained in relation to FGM and in all cases should not be a family member, not be known to the individual and not be someone with influence in the individuals community.

Thought should be given to developing a safety and support plan in case the girl/woman is seen by someone ‘hostile’ as or near a meeting place, agreeing in advance another reason why they are there.



Amendments to this Chapter

In March 2016, this chapter was extensively updated and should be read throughout.

End.