1. FGM Report Dr S K Sethi City LSCB -June 2015 Why us? Why now?

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 2

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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 1. Child at risk 2. Child has been abused through FGM 3. 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

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

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

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

11. Communities at Risk 29 practising countries in particular Somalia – 98% Sierra Leone – 90% Ethiopia - 90% Sudan – 91% In Middle East – Egypt – 97%

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.

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.