1. 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.

2. 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

3. 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

4. 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

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

6. 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

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

8. 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

9. 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!

10. 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

11. 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

12. 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

13. 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)

14. 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.

15. 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.

16. 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

17. 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 ( )

18. Female Genital Mutilation
CHILD ABUSE INVESTIGATION COMMAND
Project AZURE
Information Line:
A full briefing pack has been provided. Please read this.
Metropolitan Police
Child Abuse Investigation Command
Project Azure ( ) 18