FGM Report Dr S K Sethi City LSCB -June 2015 Why us? Why now? 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, AFRUCA, FORWARD, Crimestoppers, the Development Support agency are asking for your help to prevent Female Genital Mutilation.

What is FGM? The World Health Organisation 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 What is FGM?

types I – circumcision – removal of clitoris II – Excision – I + removal of Minora III – Infibulation – I + II + Majora IV – Piercing, chemicals, burns – everything else

Identification and Intervention There are 3 circumstances Child at risk Child has been abused through FGM Mother has undergone FGM

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!

How is FGM carried out? Varies from community to community UK 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 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

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.

Communities at Risk 29 practising countries in particular Somalia – 98% Sierra Leone – 90% Ethiopia - 90% Sudan – 91% In Middle East – Egypt – 97% The percentage rates refer to Type 3 - Infibulation

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

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 Holistic – child and Think Family Legal parameters – March 2004. Follow the set down procedures for informing your designated Child Protection Advisor In urgent cases contact Children’s Social Care, or local Police direct

Why do we need to Safeguard 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 performed on a child who is unable to resist or give informed consent FGM is illegal in the UK.