1. Violence Prevention Female Genital Mutilation
Dr Richard Fawcett FRCEM, MSc, Dip IMC (RCSE'd), MBChB, PGCE (Med Ed), VR

2. Content What is FGM UK Law Harmful Practice & Child welfare
Multi agency Approach
Health consequences
FGM in UK
Mandatory Reporting FGM
Types of FGM
Taking Action, your role.
Resources & References.

3. What is FGM?
Definition:
Female Genital Mutilation (FGM) is a collective term for a range of procedures which involve partial or total removal of the external female genitalia for non-medical reasons. It is sometimes referred to as female circumcision, or female genital cutting. The practice is medically unnecessary, is extremely painful and has serious health consequences, both at the time when the mutilation is carried out, and in later life.

4. UK LAw
In 1985 the Prohibition of Female Circumcision Act was passed within UK law stating it is an offence for any person: 1) To excise, infibulate or otherwise mutilate the whole or any part of the labia majora or clitoris of another person, or 2) To aid or abet, counsel or procure the performance of another person of any of those acts on that other person’s body. In 2003 the law was updated: Female Genital Mutilation Act 2003 making it illegal to send children abroad for the purpose of FGM. If found guilty of an offence under this act a person may be imprisoned for up to 14 years.

5. Harmful Practice & Child welfare
Any violation of human rights or issues relating to child protection must always be taken very seriously. However, with the new amendment to the FGM Act, any Health Care Professional who fails to report a case will risk losing their registration, and potentially their career. It is essential that all HCPs are aware of what FGM is and their clinical and legal responsibilities regarding the matter.

6. Multi agency Approach

7. Health consequences

8. FGM in UK
Macfarlane A and Dorkenoo E, 2014 estimated that:
Approximately 60,000 girls aged were born in England an Wales to mothers who have undergone FGM.
Approximately 103,000 women aged and 24,000 women over the age of 50 have migrated to the UK and are living with the consequences of FGM.
There are10,000 girls under the age of 15 years of age living with FGM in the UK.

9. Mandatory Reporting FGM
Section 5B of the 2003 Act introduces a mandatory reporting duty which requires regulated health and social care professionals and teachers in England and Wales to report ‘known’ cases of FGM in under 18s which they identify in the course of their professional work to the police. The duty came into force on 31 October 2015.

10. Types of FGM
FGM is often performed by traditional circumcisers or cutters who do not have any medical training. However, in some countries it may be done by a medical professional.
Anaesthetics and antiseptics aren't generally used, and FGM is often carried out using knives, scissors, scalpels, pieces of glass or razor blades.
FGM often happens against a girl's will without her consent and girls may have to be forcibly restrained.

11. Taking Action, your role.
Females over the age of 18 who have under gone FGM do not need to be referred to social services or the police. They should be supported and offered relevant follow up, should they want it. Other females within their immediate or extended family (especially those under the age of 18) should be identified and consideration should be given to their risk of FGM and need for protection
Females under the age of 18 who presents with symptoms of FGM, who discloses the fact, or you as their HCP suspect they are at risk of FGM, then it is your responsibility to report this to the police, and implement relevant safeguarding procedures as with any child abuse case. This information must be shared with the GP and health visitor as part of safeguarding actions.

12. SUMMARY
Frontline staff should be empowered to recognise and manage those patients who have undergone or are at risk of FGM by developing their knowledge and awareness of the subject. A simple to follow FGM flowchart (RCEM best practice guideline) has been developed for all ED staff to use when presented with a female patient (adult or child).

13. TRAINING & Resources
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Call to End Violence against Women & girls: Action Plan 2014.
Female Genital Mutilation Risk and Safeguarding; Guidance for professionals: DOH March 2015
Mandatory Reporting of Female Genital Mutilation – procedural information: Home Office 201
Leaflets: /FGM_leaflet.pdf
Home Office online training package:

14. References
Department of Health (2015). Female Genital Mutilation Risk and Safeguarding Guidance for professionals. Available at: 4/ _DH_FGM_Accessible_v0.1.pdf
Foundation for Women’s Health, Research and Development (FORWARD) ET AL (2007) a Statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales. Available at:
Lockhat H. (2004) Female Genital Mutilation: Treating the Tears. London: Middlesex University Press.
Macfarlane, A. J. & Dorkenoo, E. (2014). Female Genital Mutilation 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. London: City University London.
Royal College of Obstetricians and Gynaecologists (2015). Green-top Guideline No. 53 Female Genital Mutilation and its management. Accessed from; fgm.pdf
World Health Organization (1996). Female Genital Mutilation. Geneva , Switzerland : World Health Organization.

15. RCEM FGM Guideline