1. Charlita Hall & Laura Foley Female Genital Mutilation

2. Disclaimer…. WARNING……… There are images and videos in our presentation that are graphic, please feel free to turn away or leave the room.

3. Session Aims To raise awareness about FGM and to increase confidence in responding to issues Identify the prevalence who is at risk. Health implication on women and girls Identify Support

4. Talk to the person next to you……. What is FGM? Any other names? What types of FGM have you heard of? Are there any health benefits?

5. FGM also known as…. Female genital cutting-FGC ‘Circumcision’ or ‘initiation’. Niaka- Gambia Thara-Egypt Absum –Ethopia Ibi/Ugwu-Nigeria Sunna-Sierra Leone Kadin Sunneti -Turkey

6. What is FGM? https://www.google.co.uk/se arch?q=images+of+fgm&biw =1366&bih=633&source=lnms &tbm=isch&sa=X&ved=0ahU KEwjgmP_n1szJAhXEeQ8KH RujByIQ_AUIBigB#imgrc=sa _Fox7H1-e8LM%3A 6

7. FGM FGM constitutes all procedures which involve the partial or total removal of the external genitalia organ or other injury to the female genital organs, whether for cultural or any other non-therapeutic reasons (WHO, 1995). FGM is considered a grave violation of the rights of girls and women. (gov.uk, 2015) No health benefits and can often lead to morbidity and mortality in girls and women. “Trained health professionals who perform female genital mutilation are violating girls’ and women’s right to life, right to physical integrity, and right to health.”WHO, 2012

8. FGM general facts Evidence of FC dates back to the 5-7th Century BC, most data indicates religious ties Performed by midwives (daya), barbers, some doctors Most often performed without anesthesia; with razor, scissors, sharp stone, broken glass Female’s legs bound together for 40 days to heal; not allowed to move, especially for first week

9. Talk to the person next to you? Where is it practiced? Who practices it ? Why is it practiced

10. Why does FGM happen? Why the practice continues The WHO cites a number of reasons for the continuation of FGM, such as: Custom and tradition A mistaken belief that FGM is a religious requirement Preservation of virginity/chastity Social acceptance, especially for marriage Hygiene and cleanliness Increasing sexual pleasure for the male Family honour A sense of belonging to the group and conversely the fear of social exclusion Enhancing fertility

11. Cultural footings and reasons.. Conveys status and respect to the girl. Conserves a girl’s virginity/chastity. Part of being a woman. A rite of passage Gives a girl social acceptance, especially for marriage. Upholds the family honour. Cleanses and purifies the girl. Gives the girl and her family a sense of belonging to the community.

12. Meets a religious requirement believed to exist. Continues a custom/tradition. Helps girls and women to be clean and hygienic. Aesthetically desirable. Mistakenly believed to make childbirth safer for the infant. Frees the family of bad luck or evil spirit More dowry

13. Right of passage or violation of rights? Video- We AreEQUALSVideo- We AreEQUALS Leyla ( victim and activist)Leyla ( victim and activist) https://www.youtube.com/watch?v=Wj6W66RniJ8#t=1 18

14. Type 1 – Clitoridectomy: partial or total removal of the clitoris and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris). Type 2 – Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are the ‘lips’ that surround the vagina). Type 3 – Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris. Sometimes referred to as Pharaonic circumcision. Type 4 – Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterising the genital area. www.who.int/mediacentre/factsheets/fs241/en

15. www.who.int/mediacentre/factsheets/fs241/e

18. Prevalence ! Not in my back yard ! Europe Up to 500,000 girls and women living in the European Union are affected or threatened by FGM United Kingdon Dependant on the migration of people from different affected countries to a city (1999- Immigration and Asylum Seekers Act) 66,000 women in UK have undergone FGM (2001 Census figure). 22,000 girls are at risk of FGM- more might be of risk Statistical study to estimate the Prevalence of FGM (FORWARD, 2007).Highest-London, Small numbers Wales, Northwest and Midlands

19. FGM (2001 Census figure).

20. United Kingdom facts Approximately 24,000 girls under age 15 at high risk of FGM The UK legal framework Two UK Acts of Parliament are relevant in respect to FGM: Prohibition of Female Circumcision Act(1985) Female Genital Mutilation Act (1983)

21. http://content.met.police.uk/Article/Female-genital-mutiliation/1400009693144/1400009693144 FGM is Child Abuse and against the Law….. The Female Genital Mutilation Act 2003 makes it illegal to: Practice FGM in the UK To take girls who are British Nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in that country To aid, abet, counsel or procure the carrying out of FGM abroad Penalty of up to 14 years in prison or a fine Police Protection Remember your power under S46 Children Act 1989 Where a constable has reasonable cause to believe that a child would otherwise be likely to suffer significant harm he or she may Remove the child to suitable accommodation and keep him or her there Or Take reasonable steps to prevent the child's removal from hospital or other safe place Section 46 (1) Tactical Options ….Arrest ? Police Protection? - Inform the designated officer - Police Protection lasts up to 72 Hours - Inform Social Services -Create Crime report & Merlin/Pac

22. https://youtu.be/Mq3orc03Q3Y A Londoner ‘s story…… What do we as health professionals need to be aware of ?

23. Communities at Risk in the UK The migrant communities that are most at risk are – Kenyan Egyptian Nigerian Eritrean Non African communities- Yemeni, Afghani, Kurdish, Indonesian and Pakistani.

24. Health impact Discuss: Possible immediate health issues Possible longer term health issues http://www.careducation.org/admin/wp- content/uploads/2014/02/FGM- infographic.jpg

25. FGM can have a number of short-term health impacts, severe pain and shock infection injury to adjacent tissues sprains, dislocations, broken bones or internal injuries from being restrained immediate fatal hemorrhaging Infection by blood borne virus Urine retention Infection including tetanus & HIV Injury to adjacent tissue Fracture or dislocation to limbs as a result of restraint

26. Long term health consequences 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

27. What can I do? FGM is a form of child abuse, professionals have a statutory obligation under national safeguarding protocols (e.g. Working Together to Safeguard Children 2013) to protect girls and women at risk of FGM Be aware of vulnerable groups Follow local and national Policy Be compassionate and safe

28. Treat it as child abuse. Document and collect information. Share that information systematically. Empower frontline professionals. Identify girls at risk and refer them as part of child safeguarding obligations..Report cases of FGM. Hold frontline professionals accountable.. Empower and support affected girls and young women (both those at risk and survivors).. Implement awareness campaign. RCN, 2001 http://www.rcn.org.uk/__data/assets/pdf_file/0010/608914/RCNguidance_FG M_WEB2.pdf

29. Summary Illegal in the UK. Customary in 28 African countries as well as in parts of the Middle East and Asia. Approximately 103,000 women aged 15-49 and approximately 24,000 women aged 50 and over who have migrated to England and Wales are living with the consequences of FGM. Approximately 10,000 girls aged under 15 who have migrated to England and Wales are likely to have undergone FGM. Is practiced by families for a variety of complex reasons but often in the belief that it is beneficial for the girl or woman. FGM constitutes a form of child abuse and violence against women and girls, and has severe short-term and long-term physical and psychological consequence https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/3 80125/MultiAgencyPracticeGuidelinesNov14.pdf

30. Trending FGM news..

31. Key documents Tackling Female Genital Mutilation in Scotland. A Scottish model of intervention. Scottish Refugee Council and London School of Hygiene and Tropical Medicine, 2014 FGM Multi-Agency Handbook, FCO, HM Government, 2011 Tackling FGM in the UK (Intercollegiate report) The Royal College of Midwives, 2013 These reports are available at www.fgmaware.orgwww.fgmaware.org

33. References FORWARD (2014) Female genital mutilation as grounds for asylum(Webpage). Available at www.forwarduk.org (accessed December 2015) www.forwarduk.org World Health Organization. (1995). "Female Genital Mutilation: Report of a WHO Technical Working Group". Geneva: World Health Organization; pp. 9. Department of Health (2014) New FGM measures launched to ‘care, protect, prevent’(part of Girl Summit 2014: Improving the lives of girls and women in the world’s poorest countries), London: DH. Available at www.government/news (accessedDecember 2014) www.government/news Web links https://www.gov.uk/government/statistics/female-genital-mutilation-july-sept-2015-enhanced-dataset http://www.legislation.gov.uk/ukpga/1999/33/contents https://www.city.ac.uk/__data/assets/pdf_file/0003/266034/PREVALENCE-STUDY_FINAL.pdf http://www.rcn.org.uk/__data/assets/pdf_file/0010/608914/RCNguidance_FGM_WEB2.pdf

34. Resources Multi-Agency Practice Guidelines on Female Genital Mutilation (HMG 2011) (PDF, 1.63Mb).Multi-Agency Practice Guidelines on Female Genital Mutilation (HMG 2011) (PDF, 1.63Mb) Daughters of Eve Text: 07983 030 488 Website: www.dofeve.orgwww.dofeve.org FGM National Clinical Group www.fgmnationalgroup.org www.fgmnationalgroup.org info@fgmnationalgroup.org FGM Resources Department of Health leaflet about FGM (PDF, 248Kb) - other language formats are available to download from the box below Department of Health leaflet about FGM (PDF, 248Kb) Poster: Female genital mutilation of young girls is child abuse (PDF, 239Kb) Poster: Female genital mutilation the facts (PDF, 439Kb)

35. The European Institute for Gender Equality has a range of resources on FGM/C at www.eige.europa.eu/search/apachesolr_search/fgm www.eige.europa.eu/search/apachesolr_search/fgm The FGM National Clinical Group www.fgmnationalgroup.org/contact_us.htm. www.fgmnationalgroup.org/contact_us.htm Includes a useful 16 minute film on FGM for non- health professionals at www.vimeo.com/15703287#at=0 Uncut Voices Articles and access to literature on FGM www.uncutvoices.wordpress.com

36. Further help and information NSPCC- 0800 028 3550 fgmhelp@nspcc.org.uk Home Office FGM Unit- FGMEnquires@homeoffice.gsi.gov.uk