1. Female Genital Mutilation and safeguarding: how health professionals can make a difference
12th December 2017

2. Welcome How we run this session
Jennifer Bourne FGM Prevention Project Manager Trish Dyter FGM Prevention Programme Officer
12th December 2017

3. Content Recap professional responsibilities including the FGM Act
Explain Mandatory Reporting Duty
Help and advice on conversations and what to ask
Introduce the FGM Risk Indication System

4. Assumed understanding
Understand what FGM is
Physical and psychological health consequences
Global and UK prevalence

5. Legislation in England
Child abuse
Serious Crime Act 2015
Habitual residency
Female Genital Mutilation Act 2003
Offence of failing to protect a girl from FGM
Up to 14 years imprisonment
Provides lifelong anonymity for victims
Anyone involved in taking a girl outside of the U.K. to have FGM carried out
FGM protection order
Mandatory reporting duty

6. Mandatory Reporting Duty
Duty applies to all regulated professionals, health, social care and teachers
Phone the police non-emergency crime number, 101, if a girl under 18 you treat
Tells you she has had FGM
Has signs which appear to show she has had FGM.
When? As soon as possible; normally by close of the next working day; discuss with your local safeguarding lead.
If FGM has been done very recently then should be referred to Social Care and Police via immediately & without delay

8. FGM & Safeguarding Need to safeguard girls over a long period of time
Risk can, and may change
Harder to maintain professional awareness when periods of risk are unknown / difficult to predict
Risk can be identified in pregnancy if there is an immediate family history of FGM
Challenges identified in ‘remembering’ potential risk / family history
ALL pregnant women are asked about FGM at booking

9. FGM Risk Indication System
New national safeguarding system for sharing information about FGM
Smartcard access via role based access codes
Shares information about immediate family history of FGM
Introducing across 50 maternity units in England before end of March 2018
Also need to integrate systems to make sure it can be shared/seen where needed / where the girl goes

10. FGM RIS - Information Sharing
Systematically shares information, securely, with healthcare professionals who come into contact with a girl as she grows up.
Alerts other health professionals treating the girl that she is at potential risk of FGM
Prompts professionals to consider any safeguarding actions

11. Safeguarding against FGM
A family history of FGM is potentially risk
Ask directly and with confidence
Always carry out risk assessment to help decide what steps to take - using local or DH Safeguarding Guidance
Talk to your local Safeguarding Lead
Document all actions in the records
ww.gov.uk/dh/fgm - section ‘Safeguarding women and girls’

12. Safeguarding against FGM
Suggested ways of asking the question:-
Have you heard of FGM? Do you know what it means? Has it been done to you?
May need to explore further – be aware of different terms e.g. sunna or ‘being closed’
Be aware, this may be the first time they have been asked about their experiences and may trigger distress
They may not remember having had FGM if performed at a very young age
Be supportive to their repsonse

13. Safeguarding against FGM contd
Carry our Risk/Safeguarding assessment
Are there other SG concerns?
Document information and actions in healthcare records
Ensure Enhanced Data collection is completed
Explain law in the U.K.
Explain health complications of FGM
Share information with GP & HV/SN
Add information to the FGM RIS

14. Safeguarding in context
FGM may be discovered by chance (e.g. when placing a urinary catheter, carrying out a smear test)
May be disclosed by woman/child
Clinical presentation trigger (such as repeated UTIs, severe menstrual pain, infertility, PTSD, depression etc)

15. FGM Safeguarding Guidance

16. Structure within the guidance
Pregnant woman with FGM (or recently given birth)
Non-pregnant adult woman with FGM
Child/young adult under 18 may be at risk of FGM
Child/young adult under 18 with signs/symptoms which may be FGM
Level of Risk? > Action?

17. Consider: child u18 has had FGM
Action:
Mandatory Reporting Duty
Discuss with SG lead
Refer to police on 101
Document actions taken
If very recently undergone FGM, urgent referral to police and social care.

18. What might prompt you to consider FGM?
Girl has difficulty walking, sitting or standing
Girl presents to GP or A & E with frequent urine, menstrual or stomach problems
Long absence from school
Girl appears withdrawn, depressed, or has had significant change in behaviour
Girl avoids P.E./spends long time in bathroom/toilet away from classroom
Child talks about pain or discomfort between her legs

19. Paediatric examination appointment following referral
To assess, confirm and diagnose the Type of FGM
for child to see a specialist counsellor if appropriate
(N.B. Police & Social Care will investigate when & where the FGM took place)
Consider referral to specialist paediatric unit at UCLH or a local service

20. What might prompt you to consider?
Parents or child are discussing going abroad for a prolonged period
Family not engaging with health services
Girl not allowed to attend Sex and Relationship education
Girl confides that she is to have a special coming-of-age party/ceremony
A sister or other female relative is found to have had FGM
Family already known to social care

21. What action will you take?
If at imminent risk of harm
URGENT REFERRAL TO POLICE & SOCIAL CARE
Some risk identified – further action or assessment required but not an urgent/emergency referral
REFERRAL TO SOCIAL CARE
Relevant information learnt but no need to refer
RECORD information and decision
SHARE information – GP/HV/SN, social care
Add indicator on FGM RIS system to maintain safeguarding considerations for girl
RECORD in healthcare record

22. What might prompt you to consider that girl is at risk of FGM?
Does husband or other family elder support practice
Do family have knowledge of the law and health consequences of FGM
Have other children in family had FGM
Is woman attending appointments / engaging with professionals
Is she requesting reinfibulation after birth
Is she a vulnerable adult

23. What action will you take?
If risk to u18 identified, previous considerations
If over 18, no one identified as being at risk of FGM, so no need to take action under safeguarding responsibilities
NO REFERRAL REQUIRED unless patient wants support to report to police
RECORD information and decision
SHARE with GPs in line with information sharing

24. To summarise FGM is child abuse Ask questions and have confidence
Remember to consider other safeguarding concerns
Do I need to make a police report under the mandatory reporting duty?
Use the FGM RIS to share information
Do I need to seek help from my local safeguarding lead or other professional support before making a decision?
Update your client/patient’s notes/share information appropriately

25. Questions ? england.fgm.prevention@nhs.net

26. Other webinars About… the FGM RIS
Communicating about FGM as a service / organisation
FGM and mental health
The FGM enhanced dataset
Book online at NHS England website: