1. The Haamla Service and Perinatal FGM Service in Leeds Sarah Bennett Specialist Midwife, BME women

2. Bi-lingual Maternity Support Workers
Haamla Midwives
VolunteerDoulas
Haamla Antenatal Groups
Perinatal FGM Service
Health Needs Analysis
Training
Research & Audit
Evaluation

3. Bi-lingual Maternity Support Workers
Ward visits
Home visits
Feeding support
Bereavement support
Advocacy support

4. She was amazing. This project is something really good for women
Volunteer Doulas
12 weeks training course
Open College Network accredited
Antenatal/Birth/ Postnatal support
Regular supervision
On-going training
She was very nice and supported. She help me a lot in labor. I am very thankful to her
She was amazing. This project is something really good for women

5. Please keep alive this program for all new Mums in the future
Antenatal Groups
Women only
Community based
Interpreters provided
Women led topics
Attachment focussed
The information provided was very useful for me that I knew what to expect and have an idea what to do with my baby
I enjoy coming every week and have opportunity to discuss what I want and talk to other pregnant women
Please keep alive this program for all new Mums in the future

6. Haamla Midwives Caseload: Asylum seekers Destitute asylum seekers
I thank you for all your wonderful support you gave me during that period
Caseload:
Asylum seekers
Destitute asylum seekers
Homeless women
Gypsy Travellers
Some new migrants
There is not enough words to explain how much I satisfied with your midwife team. I feel I was in safe hands

7. Perinatal FGM Service
“All procedures which involve, partial or total removal of the female external genitalia, or any other injury to the female genital organs, for non-therapeutic reasons”

8. Also: Indonesia Malaysia Afghanistan Iran Israel Oman Palestine
United Arab Emirates
India
Pakistan
(UNICEF 2013)

9. Reasons/Beliefs Sustaining FGM
It brings status and respect to the girl It is a rite of passage.
It preserves a girl’s virginity/chastity. It is part of being a woman.
It gives a girl social acceptance, especially for marriage.
It upholds the family honour. It perpetuates a custom/tradition.
It cleanses and purifies the girl. It is aesthetically desirable.
It gives the girl and her family a sense of belonging to the community.
It fulfils a religious requirement believed to exist.
It helps girls and women to be clean and hygienic.
It is mistakenly believed to make childbirth safer for the infant.
It rids the family of bad luck or evil spirits.

10. Rationale for FGM service
Physical, Psychological, Sexual Health Consequences:
Short Term
Pain, severe bleeding, urine retention, infection, broken bones, death
Long Term
Chronic pain, cysts, abscesses, ulcers, scarring, recurrent infections, sexual dysfunction, subfertility, chronic anxiety, phobias, depression, PTSD
Pregnancy/Childbirth
Mother Increased risk of: recurrent urine infections, LSCS, severe perineal or vaginal trauma, severe bleeding, extended hospital stay Baby Increased risk of: poor condition at birth, low birth weight, SB, NND

11. Leeds Midwife led FGM Service
Aims
Reduce FGM morbidity & mortality
Improve women’s maternity care experience
Prevent FGM/Protect children
Meet midwives/obstetricians training need
Elements
Training
FGM Clinic
LTHT FGM Clinical Guidelines/Care Pathway

12. Training
Pre-registration training at University of Leeds undergraduate midwives
Mandatory training for postgraduate midwives
Shadowing/observation in FGM clinic
Colleagues in other departments
Leeds Safeguarding Children Board

13. LTHT Maternity Care Pathway

14. Prevalence FGM Clinic Data 2014 (n133)
New estimates, commissioned by BHI, using the 2011 Census data indicate that between 1,003 and 2,667 women and girls in Leeds have undergone, or are at risk of, FGM

15. Friendly service, very informative
What do the women say?
Is very nice service, I really love it, thank you very much. God bless you
It was good to see you today, we learned a lot. We can now share the knowledge we have with our community to help protect girls and stop circumcision from happening
Friendly service, very informative
Everything is now good

16. On-going support services
Black Health Initiative (BHI)
Solace
Psychology Services
City wide FGM Steering Group
Gaps in provision – Opportunities for funding….

17. Contact details
Any questions?

18. References
Waugh M Mothers in Exile. Womens Health Matters: Leeds. Bennett S, Scammell J Midwives caring for asylum-seeking women: research findings. Practising Midwife. 17:1 pp9-12. RCM Tackling FGM in the UK – Intercollegiate recommendations for identifying, recording and reporting RCM London HM Government Multi-Agency Practice Guidelines: Female Genital Mutilation . Macfarlane A, Dorkenoo E, FGM 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. City University, London. HM Government Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children. London: Stationery Office. NMC The code: Standards of conduct, performance and ethics for nurses and midwives West Yorkshire Consortium Procedures Manual