DEFINITION OF FGM Comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non medical reasons. World Health Organisation 2014

Female genital mutilation (FGM) violates the following human rights Declaration of the Rights of the Child 1959 The right to be free from gender discrimination The right to life and physical integrity The right to health The rights of the child All children shall enjoy special protection, and shall be given opportunities and facilities, by law and by other means, to enable them to develop physically, mentally, morally, spiritually and socially in a healthy and normal manner and in conditions of freedom and dignity A RIGHTS-BASED APPROACH

Prevalence of Female Genital Cutting Scaled 2011

Countries with the highest prevalence are: Somalia (98%) Guinea (96%) Djibouti (93%) Egypt (91%) Eritrea (89%) Mali (89%) Sierra Leone (88%) Sudan (88%) Gambia (76%) Burkina Faso (76%) Ethiopia (74%) - UNICEF KEY COUNTRIES OF ORIGIN

At birthInfancy Teenagers After birth of a child Neonatal period Childhood Before or at marriage In Nigeria, Eritrea and Mali, most girls undergo FGM be-fore the age of 5 In Somalia and Chad, most girls undergo FGM between the ages of 5-9 years In Kenya and Egypt, most girls undergo FGM after the age of 10 In 50% of cases FGM is carried out before the age of five Malaysia many under 1 year WHEN AT RISK OF FGM

Social obligation/ acceptance/ rite of passage Reducing sexual desire, fear of clitoris and sexuality, keeping virginity Religious requirement Readiness for marriage and adulthood Purify the body/clean, aesthetics Protects against material want MISCONCEPTIONS

Normal Female Genital Anatomy WHO FGM Classification: Type IV UNICEF: cut/nicked, no flesh removed FGM TYPES

UNICEF: Cut and flesh removed with or without stitching UNICEF: Cut and flesh removed

UNICEF : Cut, flesh removed and sewn closed

Immediate/short-term consequences Haemorrhage Sepsis Death Urinary retention Tetanus and gangrene Infections (e.g., HIV, Hepatitis) Long-term consequences Recurrent urinary infections Painful menstruation Pain during intercourse Keloid scarring and cysts Complications in pregnancy Infertility COMPLICATIONS OF FGM

Female Genital Mutilation Act 2003 makes it a criminal offence for any UK national or permanent resident to mutilate the whole or any part of a girl or woman’s genitalia Or to aid, abet, counsel or procure the carrying out of FGM in the UK As well as to have it carried out abroad, even in countries where the practice may be legal THE UK LAW

Using the term mutilation may be upsetting to some patients Try to be sensitive and use value-neutral terms Have you been cut down there? Were you circumcised? Have you been closed? Safeguarding women with FGM and girls at risk of undergoing FGM is everyone’s responsibility BROACHING THE TOPIC

What can YOU do? Prevention and SupportSuspicion of FGM Liaise with local support/communities e.g. FORWARD charity Identify girls at risk Empower and support affected girls and young women (both those at risk and survivors) Treat as Child Abuse - Follow Multi- Agency Practice Guidelines: Female Genital Mutilation (2011). Implement awareness campaign/passport Document and collect information and share it systematically