Female Genital Mutilation Summer is for Fun……. Not for Pain HEALTH WARNING This presentation deals with a subject that might have affected some people in the audience , or some of the audience may find the contents of this presentation upsetting and distressing. Please feel free to leave at any time However we make no apologies for this presentation – Female Genital Mutilation is Child Abuse This year the Metropolitan Police, and it’s Partners – the London Safeguarding Children Board, BMA, AFRUCA, FORWARD, Crimestoppers, ACCM and the Development Support agency are asking for your help to prevent Female Genital Mutilation.

What is FGM? 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 non-therapeutic reasons The World Health Organisation This is the internationally agreed definition by the World Health Organisation

Types of FGM Type 1 - removal of the clitoral hood with or without the removal of the clitoris Type 2 - removal of the clitoris and partial or total removal of the vaginal lips Type 3 - removal of the clitoris, vaginal lips and the stitching of the vagina, leaving a 1-2cm opening Type 4 - piercing the clitoris, cauterisation, cutting the vagina, inserting corrosive substances Communities differ in the way that FGM is carried out and in the ways that they perform FGM Different words are used by different communities and countries, not many girls or women know of the term Female Genital Mutilation The specific form that FGM takes varies from one community to another Girls and women may not know which procedure they have experienced or are going to experience Significant variation in the extent of the cutting because of the poor conditions in which FGM is performed

Who is at risk? 2 million girls around the world every year are mutilated Mainly African and Middle Eastern countries and alarmingly now in the immigrant population of Europe, America and Australia It is estimated that as many as 20,000 girls are at risk of FGM within the UK every year Any girl is at risk – usually between 4-14 FGM is practised in 28 African Countries including Egypt Also in parts of the Middle East, including Yemen, Syria and some Kurds in Northern Iraq In Asia – some parts of Pakistan and Indonesia The age at which FGM is performed varies – it depends on the ethnic group and geographical location. Can be during infancy – from a few days old During childhood – 4-10 years At the onset of Puberty At marriage During 1st pregnancy

A map of the African Continent, showing prevalence of FGM in Africa

Female Genital Cutting Areas of Practice - TYPE II                                                                    Female Genital Cutting Areas of Practice - TYPE II Type II involves the partial or entire removal of the clitoris, as well as the scraping off of the labia majora and labia minora .                                                                                                            Return to Introduction The area coloured grey indicates high prevalence of FGM

Communities at Risk 28 practising countries in Africa Djibouti – 98% Somalia – 97% Sierra Leone – 90% Ethiopia - 79.9% Sudan – 90% Guinea – 98.6% In Middle East – Egypt – 97% The percentage rates refer to Type 3 - Infibulation

How is FGM carried out? Varies from community to community but generally by an elder woman in the community using non-sterile, blunt instruments without anaesthetic UK girls are taken on “holiday” to become a woman Communities in the UK are believed to have their own practitioners here Some doctors will do this under anaesthetic It depends on the ethnic group and the geographical location FGM is usually performed in very primitive conditions by elderly women, men, Traditional Birth Attendant or a circumcisor Anaesthetic is rarely used and the child can be held down by a number of women FGM is carried out using special knives, scissors, razors or pieces of glass. Even sharp stones are reported as being used The wound is often held together with thorns and the girls legs are bound together until the wound is healed – for type 3 this can be for up to 40 days Medicalisation of FGM is condemned by the World Health Organisation

Why is FGM carried out? Religion is NOT a basis for FGM Cultural identity – A tribal initiation into adulthood Gender Identity – Moving from girl to woman – enhancing femininity Sexual control – believed to reduce the woman’s desire for sex and therefore the possibility of sex outside marriage Hygiene/cleanliness – unmutilated women are regarded as unclean and not allowed to handle food or water Again the reasons vary from community to community and are very complex: Neither the Bible, the Qu’ran nor any other religious book make any reference to FGM and it has been condemned by all religious leaders Other reasons include: Hygiene The clitoris regarded as dirty and unsightly – if a clitoris touches a man’s penis, then the penis will fall off!

Health Consequences Short term Haemorrhage Severe pain & shock Urine retention Infection including tetanus & HIV Injury to adjacent tissue Fracture or dislocation to limbs as a result of restraint

Health Consequences Long-Term Difficulty with passing urine & chronic urinary tract infections which can lead to renal problems or renal failure Difficulties with menstruation Acute & chronic pelvic infections which can lead to infertility Sexual dysfunction/Psychological/Flashbacks Complications during pregnancy Chronic scar formations

Human Rights “Female Genital Mutilation is a fundamental human rights issue with adverse health and social implications… (it) violates the rights of girls and women to bodily integrity and results in perpetuating gender inequality” UK All Parliamentary Group on Population Development and Reproductive Health (2000) This statement was made by the UK All Parliamentary Group on Population Development and Reproductive Health. It confirms that within that there is support for eliminating FGM within the government

Female Genital Mutilation Act 2003 Offence to commit FGM Offence to aid, abet, counsel or procure a girl to commit FGM Offence 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 Any act done outside UK by UK National or resident The penalty is up to 14 years imprisonment. For section 1, it is an offence for UK national to carry out FGM outside of the UK, and also to aid, abet counsel or procure. EG if a person in the UK advises his UK national brother over the phone how to carry out and FGM operation abroad, he is guilty of the offence Section 2, it is an offence for a UK national or permanent UK resident outside the UK to aid, abet counsel or procure a person of any nationality to carry out FGM on herself wherever the procedure is carried out. So for Section 3, it is an offence for a UK national or permanent UK resident outside the UK to aid, abet, counsel or procure a foreign national (who is not a UK resident) to carry out FGM outside the UK on a UK national or permanent UK resident. EG a permanent UK resident who takes his permanent UK resident daughter to the doctor’s surgery in another country so that FGM can be carried out is guilty of an offence Section 4 of the act extends sections 1,2, and 3 so that any of the prohibited acts done outside of the UK by a UK national or permanent resident will be an offence under domestic law and will be triable in the courts of England and Wales. (in Scotland the 1985 act continues to apply)

Indications that FGM may be about to take place….. The family come from a community that is known to practise FGM Parents state they will take the child out of the country for a prolonged period A child may talk about a long holiday to a country where the practice is prevalent A child may confide that she is to have a “special procedure” or celebration Professionals in all agencies and individuals and groups in the community need to be alert to the possibility of a child being at risk of, or having experienced FGM. These are a short list of potential indicators that a child may be at risk of FGM, which individually may not indicate risk, but if there are 2 or more present this could signal a risk to the child.

Indications that FGM may have already taken place….. A child may spend long periods of time away from the classroom during the day with bladder or menstrual problems Prolonged absences from School plus a noticeable behaviour change The child requiring to be excused from physical exercise without the support of their GP The child may confide in a professional or may ask for help Again this is not an exhaustive list, and no indicator should be taken in isolation Any female child born to a woman who has been subjected to FGM must be considered to be at risk, as must other female children in the extended family Any female child who has a sister who has already undergone FGM must be considered to be at risk, as must other female children in the extended family.

What do I do? You must inform your designated child protection Advisor They must make a referral to the Local Authority Children’s Social Care Follow the set down procedures for informing your designated Child Protection Advisor In urgent cases contact Children’s Social Care, or local Police direct

Female Genital Mutilation Summer is for Fun……Not for Pain The school summer holidays are a time when it is known that girls are taken out of the country to undergo FGM Report any concerns. Child protection is everyone’s responsibility FGM is a serious crime and can be fatal A full briefing pack has been provided. Please read this. Metropolitan Police Child Abuse Investigation Command Project Azure (020 7161 2888)

Female Genital Mutilation CHILD ABUSE INVESTIGATION COMMAND Project AZURE Information Line: 020 7161 2888 scd5mailbox-azure@met.police.uk A full briefing pack has been provided. Please read this. Metropolitan Police Child Abuse Investigation Command Project Azure (020 7161 2888) 18