The Haamla Service and Perinatal FGM Service in Leeds Sarah Bennett Specialist Midwife, BME women

Bi-lingual Maternity Support Workers Haamla Midwives VolunteerDoulas Haamla Antenatal Groups Perinatal FGM Service Health Needs Analysis Training Research & Audit Evaluation

Bi-lingual Maternity Support Workers Ward visits Home visits Feeding support Bereavement support Advocacy support

She was amazing. This project is something really good for women Volunteer Doulas 12 weeks training course Open College Network accredited Antenatal/Birth/ Postnatal support Regular supervision On-going training She was very nice and supported. She help me a lot in labor. I am very thankful to her She was amazing. This project is something really good for women

Please keep alive this program for all new Mums in the future Antenatal Groups Women only Community based Interpreters provided Women led topics Attachment focussed The information provided was very useful for me that I knew what to expect and have an idea what to do with my baby I enjoy coming every week and have opportunity to discuss what I want and talk to other pregnant women Please keep alive this program for all new Mums in the future

Haamla Midwives Caseload: Asylum seekers Destitute asylum seekers I thank you for all your wonderful support you gave me during that period Caseload: Asylum seekers Destitute asylum seekers Homeless women Gypsy Travellers Some new migrants There is not enough words to explain how much I satisfied with your midwife team. I feel I was in safe hands

Perinatal FGM Service “All procedures which involve, partial or total removal of the female external genitalia, or any other injury to the female genital organs, for non-therapeutic reasons”

Also: Indonesia Malaysia Afghanistan Iran Israel Oman Palestine United Arab Emirates India Pakistan (UNICEF 2013)

Reasons/Beliefs Sustaining FGM It brings status and respect to the girl. It is a rite of passage. It preserves a girl’s virginity/chastity. It is part of being a woman. It gives a girl social acceptance, especially for marriage. It upholds the family honour. It perpetuates a custom/tradition. It cleanses and purifies the girl. It is aesthetically desirable. It gives the girl and her family a sense of belonging to the community. It fulfils a religious requirement believed to exist. It helps girls and women to be clean and hygienic. It is mistakenly believed to make childbirth safer for the infant. It rids the family of bad luck or evil spirits.

Rationale for FGM service Physical, Psychological, Sexual Health Consequences: Short Term Pain, severe bleeding, urine retention, infection, broken bones, death Long Term Chronic pain, cysts, abscesses, ulcers, scarring, recurrent infections, sexual dysfunction, subfertility, chronic anxiety, phobias, depression, PTSD Pregnancy/Childbirth Mother Increased risk of: recurrent urine infections, LSCS, severe perineal or vaginal trauma, severe bleeding, extended hospital stay Baby Increased risk of: poor condition at birth, low birth weight, SB, NND

Leeds Midwife led FGM Service Aims Reduce FGM morbidity & mortality Improve women’s maternity care experience Prevent FGM/Protect children Meet midwives/obstetricians training need Elements Training FGM Clinic LTHT FGM Clinical Guidelines/Care Pathway

Training Pre-registration training at University of Leeds undergraduate midwives Mandatory training for postgraduate midwives Shadowing/observation in FGM clinic Colleagues in other departments Leeds Safeguarding Children Board

LTHT Maternity Care Pathway

Prevalence FGM Clinic Data 2014 (n133) New estimates, commissioned by BHI, using the 2011 Census data indicate that between 1,003 and 2,667 women and girls in Leeds have undergone, or are at risk of, FGM

Friendly service, very informative What do the women say? Is very nice service, I really love it, thank you very much. God bless you It was good to see you today, we learned a lot. We can now share the knowledge we have with our community to help protect girls and stop circumcision from happening Friendly service, very informative Everything is now good

On-going support services Black Health Initiative (BHI) Solace Psychology Services City wide FGM Steering Group Gaps in provision – Opportunities for funding….

Contact details sarah.bennett4@nhs.net 0113 2066392 Any questions?

References Waugh M. 2010. Mothers in Exile. Womens Health Matters: Leeds. Bennett S, Scammell J. 2014. Midwives caring for asylum-seeking women: research findings. Practising Midwife. 17:1 pp9-12. RCM. 2013. Tackling FGM in the UK – Intercollegiate recommendations for identifying, recording and reporting RCM London https://www.rcm.org.uk/sites/default/files/FGM_Report.pdf. HM Government. 2011. Multi-Agency Practice Guidelines: Female Genital Mutilation https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216669/dh_124588.pdf . Macfarlane A, Dorkenoo E,. 2014. FGM in England and Wales: Updated statistical estimates of the numbers of affected women living in England and Wales and girls at risk Interim report on provisional estimates. City University, London. HM Government. 2013. Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children. London: Stationery Office. NMC. 2008. The code: Standards of conduct, performance and ethics for nurses and midwives http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf. West Yorkshire Consortium Procedures Manual. 2014 http://westyorkscb.proceduresonline.com/chapters/contents.html