1. FGM Report Dr S K Sethi City LSCB -June 2015
Why us? Why now?
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, AFRUCA, FORWARD, Crimestoppers, the Development Support agency are asking for your help to prevent Female Genital Mutilation.

2. What is FGM? The World Health Organisation
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
What is FGM?

5. types I – circumcision – removal of clitoris
II – Excision – I + removal of Minora
III – Infibulation – I + II + Majora
IV – Piercing, chemicals, burns – everything else

6. Identification and Intervention
There are 3 circumstances
Child at risk
Child has been abused through FGM
Mother has undergone FGM

7. 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!

8. How is FGM carried out? Varies from community to community UK
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 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. 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.

10. 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.

11. Communities at Risk 29 practising countries in particular
Somalia – 98%
Sierra Leone – 90%
Ethiopia - 90%
Sudan – 91%
In Middle East – Egypt – 97%
The percentage rates refer to Type 3 - Infibulation

12. 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

13. 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

14. 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
Holistic – child and Think Family
Legal parameters – March 2004.
Follow the set down procedures for informing your designated Child Protection Advisor
In urgent cases contact Children’s Social Care, or local Police direct

15. Why do we need to Safeguard Girls and Women from FGM ?
FGM is recognised internationally as a violation of the human rights of girls and women.
FGM constitutes child abuse and causes physical, psychological and sexual harm which is life long.
FGM is performed on a child who is unable to resist or give informed consent
FGM is illegal in the UK.