West of Berkshire LSCBs Female Genital Mutilation (FGM) Toolkit
This toolkit has been developed in order for professionals to understand, identify and
respond to FGM. The aim is for the toolkit to support a robust multi-agency and community
approach to safeguarding children and females at risk of FGM across the west of Berkshire.
The toolkit has been produced in conjunction with colleagues from Reading, West Berkshire
and Wokingham Borough Councils Children’s Social Care Services, Thames Valley Police,
Royal Berkshire Hospital, Berkshire Healthcare Foundation Trust and colleagues from the
Berkshire West CCGs.
This FGM toolkit is made up of three parts and professionals should familiarise themselves
with each element and read them in conjunction.
FGM Toolkit – 3 part toolkit
Part 1 – FGM Guidance and Resources
Page 2
Part 2 – FGM Pathways
Page 12
Part 3 – FGM Risk Assessment Tool
Page 23
Updated: March 2017
1
Part 1 - FGM Guidance and Resources
The purpose of this section is to provide an understanding of FGM, the statutory guidance
on FGM in the UK and how professionals should respond to FGM via using Part 2 and Part 3
of this toolkit. This section also signposts to local, regional and national resources for FGM
support.
Contents
1.
2.
3.
4.
5.
What is FGM
Prevalence in UK
Health Implications
Legislation on FGM
Professional Responsibility in relation to FGM
a.) Mandatory Reporting Duty
b.) Professionals Not Subject to the Mandatory Reporting Duty
c.) Safeguarding suspicions and failure to protect
6. How to use the Pathways and Risk Assessment Tool
7. Resources
1. What is FGM?
FGM is defined by the World Health Organisation as all procedures that involve partial or
total removal of the external female genitalia, or other injury to the female genital organs
for non-medical reasons.
According to the World Health Organisation (WHO), FGM is practiced in up to 28 African
countries and in some countries in the Middle East and Asia.
FGM has been classified by the World Health Organisation (WHO) into four types:
•
•
•
•
Type 1 – Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and
erectile part of the female genitals) and, in very rare cases, only the prepuce (the
fold of skin surrounding the clitoris);
Type 2 – Excision: partial or total removal of the clitoris and the labia minora, with or
without excision of the labia majora (the labia are the ‘lips’ that surround the
vagina);
Type 3 – Infibulation: narrowing of the vaginal opening through the creation of a
covering seal. The seal is formed by cutting and repositioning the inner, or outer,
labia, with or without removal of the clitoris; and
Type 4 – Other: all other harmful procedures to the female genitalia for non-medical
purposes, e.g. pricking, piercing, incising, scraping and cauterising the genital area.
2
FGM is performed on women and girls at different ages, depending on the community or
ethnic group that carries it out, though it is mostly carried out on girls between the ages for
5 and 8 years old. The procedure is traditionally carried out by women with no medical
training.
There are a number of different reasons why FGM is performed. The process is often seen
as part of the family’s culture, it is also seen as a right of passage. FGM is often important
for the cultural identity of girls and women and may also impact a sense of pride, a coming
of age and a feeling of community. Those girls and women who refuse can often face being
ostracised and condemned by their communities. Religion can also be a justification for
FGM, though it is practised by both religious and secular communities.
2. Prevalence in the UK
It is recognised that women and girls may also be at risk of having FGM performed on them
in the UK, or being taken from the UK to have the procedure performed overseas.
In the UK, FGM tends to occur in areas with large population of FGM practicing
communities. The home office has identified girls from Somali, Guinean, Kenyan, Sudanese,
Sierra Leonean, Egyptian, Nigerian, Eritrean, Yemeni, Kurdish and Indonesian communities
as the most at risk of FGM.
The prevalence of FGM in England and Wales is difficult to estimate because of the hidden
nature of the crime. However, a 2015 study estimated that:
•
Approximately 60,000 girls aged 0-14 were born in England and Wales to mothers who
had undergone FGM; and
•
Approximately 103,000 women aged 15-49 and approximately 24,000 women aged 50
and over who have migrated to England and Wales are living with the consequences of
FGM. In addition, approximately 10,000 girls aged under 15 who have migrated to
England and Wales are likely to have undergone FGM.
3. Health Implications
FGM can impact on the health of girls and women both long and short term. Short term
health consequences of the practice can include infections, severe pain, emotional and
psychological shock. Longer term consequences for women can be severe and wide ranging,
including, chronic infections, renal impairment, complications during pregnancy and
childbirth, psychological issues, including depression and post stress-traumatic stress
disorder, increased risk of sexually transmitted infections.
FGM is a criminal offence – it is child abuse and a form of violence against women and girls,
and therefore should be treated as such. Cases should be dealt with as part of existing
3
structures, policies and procedures on child protection and adult safeguarding. There are,
however, particular characteristics of FGM that front-line professionals should be aware of
to ensure that they can provide appropriate protection and support to those affected.
4. Legislation on FGM
Female Genital Mutilation Act 2003
Under section 1(1) of the 2003 Act, a person is guilty of an offence if they excise, infibulate
or otherwise mutilate the whole or any part of a girl’s labia majora, labia minora or clitoris.
Section 6(1) of the 2003 Act provides that the term “girl” includes “woman” so the offences
in sections 1 to 3 apply to victims of any age.
Other than in the excepted circumstances set out in sections 1(2) and (3) of the 2003 Act, it
is an offence for any person (regardless of their nationality or residence status) to:
•
•
•
perform FGM in England or Wales (section 1 of the 2003 Act);
assist a girl to carry out FGM on herself in England or Wales (section 2 of the 2003 Act);
and
assist (from England or Wales) a non-UK national or UK resident to carry out FGM
outside the UK on a UK national or UK resident (section 3 of the 2003 Act).
Provided that the FGM takes place in England or Wales, the nationality or residence status
of the victim is irrelevant. Any person found guilty of an offence under section 1, 2, or 3 of
the 2003 Act is liable to a maximum penalty of 14 years’ imprisonment or a fine (or both)
The Serious Crime Act 2015 amends the Female Genital Mutilation Act 2003 to now:
• Create a new offence under section 3A of the 2003 Act of failing to protect a girl
from FGM with a penalty of up to 7 years in prison or a fine or both. - A person is
liable if they are “responsible” for a girl at the time when an offence is committed.
This will cover someone who has “parental responsibility” for the girl and has
“frequent contact” with her and any adult who has assumed responsibility for caring
for the girl in the manner of a parent. This could be for example family members,
with whom she was staying during the school holidays;
•
Introduce Female Genital Mutilation Protection Orders (“FGMPO”) - breaching an
order carries a penalty of up to five years in prison. The terms of the order can be
flexible and the court can include whatever terms it considers necessary and
appropriate to protect the girl or woman;
•
Allow for the lifelong anonymity of victims of FGM – prohibiting the publication of
any information that could lead to the identification of the victim. Publication covers
all aspects of media including social media;
4
•
Extend the extra-territorial reach of Female Genital Mutilation (FGM) offences to
include “habitual residents” of the UK, and;
•
Create a new duty of Mandatory Reporting of Female Genital Mutilation for
regulated professionals in health and social care professionals and teachers in
England and Wales.
5. Professional Responsibility in relation to FGM
a.) FGM Mandatory Reporting Duty
Section 5B of the 2003 Act places 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 applies to all regulated professionals (as defined in section 5B (2)(a), (11) and (12)
of the 2003 Act) working within health or social care, and teachers.
It therefore covers:
a)Health and social care professionals regulated by a body which is overseen by the
Professional Standards Authority for Health and Social Care (with the exception of the
Pharmaceutical Society of Northern Ireland). This includes those regulated by the:
General Chiropractic Council
General Dental Council
General Medical Council
General Optical Council
General Osteopathic Council
General Pharmaceutical Council
Health and Care Professions Council (whose role includes the regulation of social
workers in England)
Nursing and Midwifery Council;
b)Teachers - this includes qualified teachers or persons who are employed or engaged to
carry out teaching work in schools and other institutions, and, in Wales, education
practitioners regulated by the Education Workforce Council;
c)Social care workers in Wales.
‘Known’ cases are those where either a girl informs the person that an act of FGM –
however described – has been carried out on her, or where the person observes physical
signs on a girl appearing to show that an act of FGM has been carried out and the person
5
has no reason to believe that the act was, or was part of, a surgical operation within section
1(2)(a) or (b) of the FGM Act 2003.
The legislation requires regulated health and social care professionals and teachers in
England and Wales to make a report to the police where, in the course of their professional
duties, they either:
a) are informed by a girl under 18 that an act of FGM has been carried out on her; or
b) observe physical signs which appear to show that an act of FGM has been carried out on a
girl under 18 and they have no reason to believe that the act was necessary for the girl’s
physical or mental health or for purposes connected with labour or birth.
Reports under the duty should be made as soon as possible after a case is discovered. LSCB
advice is that the reporting professional seeks the support of their designated safeguarding
lead within their agency/setting as part of this process. This fulfils their mandatory/
professional duty and continues to include the safeguarding lead in the information loop,
thereby supporting the onward process going forward for the child and family.
A failure to report the discovery in the course of their work could result in a referral to their
professional body. The Home Office has produced guidance Mandatory Reporting of Female
Genital Mutilation – procedural information to support this duty and a fact sheet on the
New Duty for Health and Social Care Professionals and Teachers to Report Female Genital
Mutilation (FGM) to Police.
b.) Professionals not subject to the Mandatory Reporting Duty
While the duty is limited to the specified professionals described above, non-regulated
practitioners still have a general responsibility to report cases of FGM, in line with wider
safeguarding frameworks. If a non-regulated professional becomes aware that FGM has
been carried out on a girl under 18, they should still share this information within their local
safeguarding lead, and follow procedures outlined in this guidance.
c.) Safeguarding suspicions and failing to protect
The Mandatory Reporting Duty relates only to known cases. Where a professional,
practitioner or other person has grounds to suspect a risk that FGM is likely to take place
then local safeguarding procedures should be invoked. See also pathway 1 below for
example.
While parents and carers may genuinely believe that it is in the girl’s best interest to
conform to their prevailing custom, professionals should work in a sensitive manner with
families to explain the legal position around FGM in the UK. The families will need to
understand that not only are FGM and re-infibulation (the process of resealing the vagina
after childbirth) illegal in the UK but it is also illegal for those in positions of parental
responsibility with frequent contact with the child to fail to protect them from FGM
6
(conducted anywhere in the world). Professionals conducting either s47 or s17 enquiries
may provide families with a concise leaflet available in different languages for families to
take overseas, the Government’s “Statement Opposing FGM”.
6. How to use the Pathways and Risk Assessment Tool
The tools have been designed for the purpose of setting a uniform and consistent approach
to dealing with suspected and actual cases of FGM.
The tools available:
Part 1: FGM Pathways
The FGM pathways identify the support available for the differing
groups at risk of FGM or that have undergone FGM:
1. Girl under 18 years at risk of or suspected to have undergone
FGM
2. Girl under 18 years who has undergone FGM
3. Pregnant woman who has undergone FGM
4. Non-pregnant woman who has undergone FGM
Each pathway comes with guidance on how to discuss and
investigate FGM with the individual in order to obtain valuable
information.
These have been identified in line with national best practice and
aim to safeguard and support the individuals and/or female family
members. The pathways recognise that FGM is an offence that
can happen to females of any age and that it can be discovered at
any stage of life.
Part 2 FGM Risk
Assessment Tool
After completion of the Risk Assessment tool, the corresponding
pathway identifies the next steps to be taken by the professional.
It also lists what happens following the referral being made.
The FGM Risk Assessment tool aims to support the professional in
deciding whether FGM is a risk or whether it has already
happened and also assesses the circumstances of the individual.
The tool allows for information collation on commonly associated
circumstances with FGM. The purpose of the tool is to facilitate a
conversation about FGM between the professional and individual
being assessed. The tool will help to clarify which FGM pathway is
relevant to the situation and will lead to appropriate actions
taking place depending on the pathway it fits.
The tool can also be used as evidence for decision making and
other purposes, if for example out of fear (or any other reason)
the victim or potential victim is afraid to disclose what has
happened at a later stage.
7
The following principles should be adopted by all agencies in relation to identifying and
responding to those at risk of, or who have undergone FGM, and their parent(s) or
guardians:
•
•
•
•
•
•
•
the safety and welfare of the girl is paramount;
all agencies should act in the interests of the rights of the girl as stated in the United
Nations Convention on the Rights of the Child (1989);
Not only is FGM illegal in the UK but it is also a UK crime for those in positions of
parental responsibility to fail to protect girls from it anywhere in the world;
FGM is an extremely harmful practice and responding to it cannot be left to personal
choice;
assess whether the female requires adult safeguarding support;
accessible, high quality and sensitive health, education, police, social care and voluntary
sector services must underpin all interventions; and
as FGM is often an embedded social norm, engagement with families and communities
plays an important role in contributing to ending it.
If you:
•
•
•
suspect FGM has taken place,
there is a risk of FGM taking place or,
have confirmation that FGM has taken place,
you should complete the Risk Assessment tool as soon as possible and then refer to the
relevant pathway and follow the steps set out in that pathway.
Undertaking the risk assessment - Girls under 18
Professional judgement should be exercised when completing the Risk Assessment tool with
a girl under 18. Where possible, we advise that the tool is completed with, or by, the agency
safeguarding lead. However, due to the sensitive nature of the topic, a girl may not feel
comfortable enough to disclose the matter except to specific professionals whom the girl
trusts enough to confide in. In such cases, the safeguarding lead will need to support the
girl’s preferred professional to undertake the assessment. Following the assessment, the
professional should then seek advice from the safeguarding lead, regarding the actions to be
taken and both should refer to the, corresponding pathway.
The professional and/or safeguarding lead should undertake the risk assessment in a
planned way. Please consider the timing of the assessment, so as to ensure that the girl is
kept safe to allow for social care and the police to undertake any investigations and actions
required to safeguard the girl.
8
We advise, that for example, if a girl is at school, that the assessment be undertaken in the
morning. Therefore, if a referral to the police and/or social care is required, the girl will
remain safe at school whilst an investigation is undertaken. If an assessment is undertaken
in the afternoon, and the girl goes home and makes her parents aware of the assessment
and any referral, this will place her at increased risk of harm.
If you suspect FGM has taken place, from observation of physical behaviour (such as visible
discomfort shown by the girl), seek to get verbal confirmation by the girl and complete the
FGM Risk Assessment tool Pathway 2. If you are unable to get verbal confirmation,
complete the FGM Risk Assessment tool Pathway 1 and follow the corresponding pathways
steps. Under no circumstances are professionals to conduct a physical examination of the
girl.
Always remember that the girl’s safety is paramount.
Adults
When completing the FGM Risk Assessment tool with an adult, the professional should be
mindful that:
•
•
•
•
•
the female may not know FGM has taken place (if she was young when it
happened);
if pregnant, the safety of the unborn child should be considered; complete the Risk
Assessment tool;
if the female has female relatives (under 18/adults) who are at risk of or have
undergone FGM seek to complete the Risk Assessment tool as appropriate to your
role;
if the female is a “vulnerable adult” (for example, learning disabilities or a domestic
abuse survivor), the professional should contact adult social care safeguarding or
the police; and
the female may refuse the clinical and therapeutic support available, and not want
the support.
Offers should be made to support women who have undergone FGM but protection and
intervention must also take place for daughters/female siblings and other female relatives
under the age of 18 who are at risk of or have undergone FGM.
9
8. Resources
Local
•
ACRE – FGM support in Reading:
http://www.acre-reading.org/
•
Trust House Reading:
http://trusthousereading.org/
•
Woman with Vision – FGM Survivors Group:
Jammie Koroma
Tel: 07737038629 or [email protected]
Regional
•
Oxford Rose Clinic
http://oxfordagainstcutting.org/rose-community/
•
African Well Women’s Clinic
Guy’s & St. Thomas’s Hospital, 8th Floor – c/o Antenatal Clinic, Lambeth Palace Rd,
London, SE1 7EH
Tel: 0207 188 6872
•
African Well Women’s Clinic - Antenatal Clinic
Central Middlesex Hospital, Acton Lane, Park Royal, London, NW10 7NS
•
African Well Women’s Clinic - Antenatal Clinic
Northwick Park & St. Mark’s Hospital,Watford Rd.
Harrow, Middlesex, HA1 3UJ
•
African Well Women’s Clinic
Whittington Hospital, Level 5, Highgate Hill, London, N19 5NF
Tel: 0207 288 3482 ext. 5954
•
African Women’s Clinic
University College Hospital, Huntley St. London, WC1E 6DH
Tel: 0207 387 9300 ext. 2531
National
•
For the latest statutory guidance and policy development on FGM, please visit the
FGM unit website on:
https://www.gov.uk/government/collections/female-genital-mutilation
10
•
FGM National Clinical Group
UK-based charity dedicated to working with women who have been affected by FGM
and other related difficulties.
http://www.fgmnationalgroup.org/
•
NSPCC FGM
NSPCC support available for FGM
https://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/femalegenital-mutilation-fgm/
•
The Dahlia Project
Support group for women who have undergone FGM, in partnership with the Maya
Centre and Manor Gardens, Islington.
http://www.mayacentre.org.uk/dahlia-project-survivors-fgm/
•
Forward UK
The Foundation for Women's Health, Research and Development (FORWARD) is the
leading campaign and support charity providing help with FGM, including
counselling, referrals, information, materials and training.
http://www.forwarduk.org.uk/
•
The Orchid Project
Charity advocating toend the silence and taboo around FGM and campaigning to end
the practice.
http://www.orchidproject.org/
•
Women's Resource Centre
Charity supporting women's organisations to be more effective and sustainable.
http://www.wrc.org.uk/
•
World Health Organisation (WHO)
The United Nations public health arm. Informing, monitoring and leading standards
in international health policy.
http://www.fgmnationalgroup.org/
11
Part 2 - FGM Pathways
Pathway 1
Girls (including unborn child) under 18 years at risk of FGM or suspected to have
undergone FGM (please refer to pathway map 1 – page 15)
Information sharing and consent
1. If the girl has been spoken to and it is necessary to refer to the police or children’s social
care/MASH, the professional must ensure the girl is safe until the police/social care are
able to determine the level and urgency of risk.
2. Due to the nature of FGM, where the girl is assessed to be at risk the professional must not
inform or seek consent from parents to refer to social care as this is likely to increase the risk
to the girl.
3. Professionals should discuss any concerns and assessment of risk with their designated/named
safeguarding lead or manager to inform next steps, as long as this does not build in
unnecessary delay in taking protective action or making a referral.
When a girl is at risk of FGM
1. Where professionals have concerns that a girl may be at risk of FGM they should refer to
their safeguarding lead (where in place) or manager and together arrange completion of
the FGM Risk Assessment tool. If at any stage there are concerns that the girl is at risk of
immediate harm either during or prior to undertaking the assessment then the
professional must dial 999 and ask for police assistance.
2. Where the girl is not at immediate risk the FGM Risk Assessment tool should be
completed and referred to Children’s Social Care/MASH where the girl is resident.
Completion of the risk assessment should not prevent a referral to Children’s Social Care
or police where such action is deemed appropriate to safeguard the girl. Professionals
must use their professional judgement and consult with their safeguarding lead. Where
the Police have been contacted in the first instance they will contact Children’s Social
Care/MASH where the girl is resident.
When a girl is suspected to have undergone FGM
3. Where the girl is suspected to have undergone FGM the professional should inform their
safeguarding lead and make an immediate referral to Children’s Social Care.
12
Action following referral to Children’s Social Care/MASH
4. Children’s Social Care will initiate a Strategy Discussion with Police, Health and other
professionals as necessary to determine the nature and immediacy of any risk and agree
actions required to safeguard the girl. The strategy discussion will also consider the risk
to any female siblings or relatives under 18 and any actions required to ensure they are
safeguarded as per the process below.*
5. From the strategy discussion there will be 2 possible outcomes:
•
•
Where the girl is assessed to be at risk of harm a child protection (s47) enquiry will
be initiated
Where the girl has been assessed not to be at risk but may be in need of support
(including any health interventions) the Child In Need (s17) process will be initiated
or support provided via early help services as appropriate
S47 Outcome
6. As part of the s47 enquiry it will be necessary to consider immediate action to safeguard
the girl and this may include applying to the Courts for an FGM Protection Order or
Emergency Protection Order. In such cases the girl will be placed in the care of the Local
Authority. The police may also exercise their powers of protection to remove a child to
safety or keep a child in a place of safety (a hospital for example).
7. Where the s47 enquiry concludes that the girl is at ongoing risk of harm then a multiagency child protection conference will be held to determine actions necessary to
address the risks and the girl will be subject of a child protection plan.
S17 Outcome
8. Where the girl is not assessed to be at risk but is in need of support this will be via the
s17 process. A Child In Need assessment will normally be undertaken the outcome of
which will be either a child in need plan or support offered via early help services.
Keep asking questions
9. Professionals should always take opportunities to discuss and understand changes to
the girl’s family circumstances, and look out for whether there is a change in relation
to any of the known risk factors. For example, if the professional becomes aware of
new travel plans or the arrival of extended family members to live with the girl, this
information should be shared with Children’s Social Care/MASH and the safeguarding
procedures followed.
13
10. If you are making a referral to children’s social care (pathway 1) a copy of the FGM risk
assessment should accompany the referral.
11. Any completed risk assessments need to be stored securely or destroyed in line with
your agency’s data protection and document retention policies.
14
15
Pathway 2
Girls under 18 years who has undergone FGM (please refer to pathway map 2 – page 18)
Information sharing and consent
1. If the girl has been spoken to and it is necessary to refer to the police or children’s
social care/MASH, the professional must ensure the girl is safe until the police/social
care are able to determine the level and urgency of risk.
2. Due to the nature of FGM, where the girl is assessed to be at risk the professional must not
inform or seek consent from parents to refer to social care as this is likely to increase the
risk to the girl.
3. Professionals should discuss any concerns and assessment of risk with their
designated/named safeguarding lead or manager to inform next steps, as long as this does
not build in unnecessary delay in taking protective action or making a referral.
1. There may be a number of ways in which a professional becomes aware that a girl
under 18 has undergone FGM:
• Via completion of the FGM risk assessment tool with the girl
• The girl may disclose she has undergone the procedure
• Observation of physical indicators
• An adult may disclose (as part of the risk assessment or otherwise) that a female
relative under 18 has undergone FGM – please note there is no mandatory reporting
duty in these cases
2. In any of these circumstances the professional should discuss the concerns with their
safeguarding lead (where in place) or manager and consider whether any immediate
medical treatment is required. If so then this must be sought for the girl without
delay. Under no circumstances must the girl be physically examined to determine
whether FGM has taken place.
3. Regardless of whether medical treatment is sought, there is a mandatory reporting
requirement for health, teaching and social care professionals to report ‘known’
cases of FGM to the police. (Please see page 6 for the definition of known).
Professionals not subject to mandatory reporting requirements should refer directly
to Children’s Social Care/MASH where the girl is resident. Where the professional
has reported the matter to the police as part of their mandatory reporting
requirements the police will contact Children’s Social Care/MASH where the girl is
resident.
16
4. Children’s Social Care will initiate a Strategy Discussion with Police, Health and other
professionals as necessary to determine the nature and immediacy of any risk and
agree actions required to safeguard the girl. The strategy discussion will also
consider the risk to any female siblings or relatives under 18 and any actions
required to ensure they are safeguarded as per Pathway 1 and 2.
5. From the strategy discussion there will be a number of possible outcomes:
•
•
•
Where the girl is assessed to be at ongoing risk of harm a child protection (s47)
enquiry will be initiated
Where the girl has been assessed not to be at ongoing risk of harm but may be in
need of support (including any health interventions) the Child In Need (s17) process
will be initiated
Referral to early help services
6. As part of the s47 enquiry it will be necessary to consider immediate action required
to safeguard the girl including any protective orders.
Keep asking questions
7. Where the girl is not assessed to be at ongoing risk but is in need of support this will
be via the s17 process. A Child In Need assessment will normally be undertaken the
outcome of which will be either a Child In Need plan or support offered via early help
services.
8. Any completed risk assessments need to be stored securely or destroyed in line with
your agency’s data protection and document retention policies.
17
18
Pathway 3
Pregnant woman who has undergone or suspected to have undergone FGM (please refer
to pathway map 3 – page 20)
1. Any professional who has become aware that a pregnant woman has undergone or is
suspected to have undergone FGM should discuss their concerns with their safeguarding
lead (where in place) or manager and together agree completion of the FGM risk
assessment.
2. The professional completing the FGM risk assessment should consider with the pregnant
woman any health or wellbeing requirements and refer her to her GP or maternity
services and refer to adult social care as necessary.
3. As part of completing the FGM Risk Assessment tool, professionals must consider
whether there are any female siblings or relatives of the pregnant woman under the age
of 18 and if so whether there are indicators that they may be at risk of FGM; may have
undergone FGM or has undergone FGM.
4. If there are indicators that female siblings, relatives, unborn child or daughters under
the age of 18 are at risk of FGM or suspected to have undergone FGM, the professional
must consider any immediate protective action required to safeguard the girl and refer
to Children’s Social Care/MASH in the area the girl resides and follow Pathway 1. It is
not necessary for the professional to complete an FGM Risk Assessment on the girl prior
to referring to Children’s Social Care/MASH.
5. If there is confirmation that female siblings, relatives, or daughters of the pregnant
woman under the age of 18 have undergone FGM the professional should follow
Pathway 2. It is not necessary for the professional to complete an FGM Risk Assessment
on the girl prior to referring to Children’s Social care/MASH. Please note there is not a
mandatory reporting duty in these cases unless the girl has confirmed to the
professional they have undergone FGM.
6. Any completed Risk Assessments need to be stored securely or destroyed in line with
your agency’s data protection and document retention policies.
19
20
Pathway 4
Non-pregnant woman who has undergone or suspected to have undergone FGM (please
refer to pathway map 4 – page 22)
1. Where a woman has undergone or is suspected to have undergone FGM the
professional should complete the FGM Risk Assessment tool.
2. The professional completing the FGM Risk Assessment tool should consider with the
woman any health or wellbeing requirements and refer her to her GP or health services;
community organisations. They should also assess whether it is appropriate to refer to
adult social care and police where there are safeguarding concerns.
3. As part of completing the FGM Risk Assessment tool, professionals must consider
whether there are any female siblings, relatives or daughters of the woman under the
age of 18 and if so whether there are indicators that they may be at risk of FGM; may
have undergone FGM or has undergone FGM.
4. If there are indicators that female siblings, relatives, or daughters under the age of 18
are at risk of FGM or suspected to have undergone FGM, the professional must consider
any immediate protective action required to safeguard the girl and refer to Children’s
Social Care/MASH in the area the girl resides and follow Pathway 1. It is not necessary
for the professional to complete an FGM risk assessment on the girl prior to referring to
Children’s Social care/MASH.
5. If there is confirmation that female siblings, relatives, or daughters of the woman under
the age of 18 have undergone FGM the professional should follow Pathway 2. It is not
necessary for the professional to complete an FGM Risk Assessment on the girl prior to
referring to Children’s Social Care/MASH. Please note there is not a mandatory
reporting duty in these cases unless the girl has confirmed to the professional they
have undergone FGM.
6. There is no requirement for automatic referral of adult women with FGM to adult social
services or the police. Professionals should be aware that any disclosure may be the
first time that a woman has ever discussed her FGM with anyone. A referral to the
police should not be an automatic response for all adult women who are identified as
having had FGM; cases must individually assessed.
7. Professional should seek to support women by offering referral to community groups
who can provide support, or other services as appropriate. In all cases it is also
important to consider whether the woman and/or her family are known to social care,
and whether there are any existing safeguarding arrangements in place.
21
8. Any completed Risk Assessments need to be stored securely or destroyed in line with
your agency’s data protection and document retention policies.
22
Part 3 – Female Genital Mutilation (FGM) Risk Assessment Tool
Pathways:
1.
2.
3.
4.
Girl under 18 years at risk of or suspected to have undergone FGM
Girl under 18 years who has undergone FGM
Pregnant Woman who has undergone FGM
Non-pregnant Woman who has undergone FGM
•
Ask more questions – if one indicator leads to a potential area of concern, continue the discussion in this area.
•
Consider risk – if one or more indicators are identified, you need to consider what action to take. You should discuss the assessment and action
required with your named/designated safeguarding lead (where in place) or manager. If unsure about the level of risk, contact to Children’s Social
Care for advice.
•
If you assess the risk of harm to be immediate you must dial 999 and ask for police assistance. If you assess the girl to be at risk of harm then you need to
refer to children’s social care/MASH as a matter of urgency. Due to the nature of FGM, where a girl is assessed to be at risk the professional must not
inform or seek consent from parents to refer to social care as this is likely to increase the risk to the girl.
•
The risk indicators in the tool are ordered from higher to lower rated risk. Some of the lower rated risks may not be significant individually but may
indicate increased risk when considered together. They also provide wider information about the circumstances relevant to FGM and will support
further decision making.
Please remember: A mandatory reporting duty to the police applies to health professionals, teachers and social workers for any girl under 18 that has
undergone FGM.
Family Details
Adult Name:
DoB
Address:
Girl Name:
DoB:
Address
Ethnicity:
Family’s Country of Origin
Communication:
Can parents speak English? Interpreters
used? If so what language?
Preferred terminology for
FGM:
23
When talking about FGM
professionals should:
Pathway 1 – Girl under 18 years at risk of or suspected to have undergone FGM
Indicator
A girl or sibling asks for help
A parent or family member expresses concern
that FGM may be carried out on the girl
Girl has a sister or other female girl relative
who already undergone FGM
Girl has confided in another that she is to have
a special procedure or to attend a special
occasion either in or out of the UK. Girl has
talked about ‘going away to become a woman’
or ‘to become like my mum or sister’
Girl has spoken about a long holiday to her
country of origin or another country where
practice of FGM is prevalent
FGM is referred to in conversation by the girl,
family or close friends of the girl
Mother/Family has limited contact with the
outside
Mother, Father or Carer are known to come
from a community that practice FGM,
considering the wider family structure and
ethnicity
Girl withdrawn from PHSE lessons or from
learning about FGM - School Nurse should
have conversation with girl
Parents say that they or a relative will be
taking the girl abroad for a prolonged period –
this may not only be to a country with high
Yes
No
Unknown
Comments
- Ensure that a female
professional is available to
speak to if the girl would prefer
this.
- Make no assumptions.
- Give the girl time to talk and be
willing to listen.
- Create an opportunity for the
girl to disclose, seeing the girl on
their own in private.
- Be sensitive to the intimate
nature of the subject. No looks of
horror.
- Be sensitive to the fact that the
girl may be loyal to their parents.
- Be non-judgemental (pointing
out the illegality and health risks of
the practice, but not blaming the
girl).
- Get accurate information about
the urgency of the situation if the
girl is at risk of being subjected to
the procedure.
- Take detailed notes.
- Record FGM in the girl’s
healthcare record, as well as
details of any conversations.
- If the girl has been spoken to
and it is necessary to refer to the
police or children’s social
care/MASH, the professional
must ensure the girl is safe until
the police/social care are able to
determine the level and urgency
of risk.
24
Indicator
prevalence, but this would more likely lead to
a concern
Sections missing from the Red book. Consider
if the girl has received immunisations, do they
attend clinics etc
Grandmother or Female Family Elder e.g.
Grandmother, ‘Auntie’ is influential in the
family if FGM is a risk
Grandmother or Female Family Elder who will
be involved in the care of the girl if FGM is a
risk
Yes
No
Unknown
Comments
Parents do not know about harmful effects of
FGM and UK Law
Attended a travel clinic or equivalent for
vaccinations for her country of origin or
country where practice is prevalent
Outcome: Please refer back to the pathway guidance
•
•
•
•
•
Discuss assessment with Safeguarding Lead/Manager
If the girl (or any other girls) is assessed to be at immediate risk the police must be contacted as a
matter of urgency
If the girl (or any other girls) is assessed to be at risk of harm, refer to Children’s Social Care/MASH.
Parents should not be informed at this stage
If you are unsure of the level of risk please refer to Children’s Social Care/MASH for advice
Use simple language and ask
straight forward questions such as:
- “Did you go there/Will you go there
for a “special occasion”?”
- “Have you been cut down there?”
- “Do you remember when it
happened to you? Do you know who
did it?”
- “Do you know anyone else who has
had the same thing happen to
them?”
- If the answer is yes, sensitively
question further.
Be direct, as indirect questions can
be confusing and may only serve to
compound any underlying
embarrassment or discomfort that
you or the girl may have.
Be supportive:
- “I am going to help you.”
- “Are you worried about..?”
Any additional actions:
25
When talking about FGM
professionals should:
Pathway 2 – Girl under 18 years who has undergone FGM
Indicator
Girl asks for help
Girl confides in professional that FGM has
taken place
Mother/Family member discloses that a
female girl has had FGM
Girl has difficulty walking, sitting, standing or
looking uncomfortable, which was not
previously a problem
Girl finds it hard to sit still for long periods of
time, which was not previously a problem
Girl presents to GP/A&E/School with frequent
urine, menstrual or stomach problems that
were not previously a problem and often
means spending a long time in the
bathroom/toilet
Girl is taken sick at school and is reluctant to
share details
Girl complains of pain and/or discomfort
between her legs
Girl has spoken about a long holiday to her
country of origin or another country where
practice of FGM is prevalent
Noticeable behaviour changes following a
Yes
No
Unknown
Comments
- Ensure that a female
professional is available to
speak to if the girl would prefer
this.
- Make no assumptions.
- Give the girl time to talk and be
willing to listen.
- Create an opportunity for the girl
to disclose, seeing the girl on their
own in private.
- Be sensitive to the intimate
nature of the subject. No looks of
horror.
- Be sensitive to the fact that the
girl may be loyal to their parents.
- Be non-judgemental (pointing
out the illegality and health risks of
the practice, but not blaming the
girl).
- Get accurate information about
the urgency of the situation if the
girl is at risk of being subjected to
the procedure.
- Take detailed notes.
- Record FGM in the girl’s
healthcare record, as well as
details of any conversations.
- If the girl has been spoken to
and it is necessary to refer to the
police or children’s social
care/MASH, the professional
must ensure the girl is safe until
the police/social care are able to
determine the level and urgency
of risk.
26
Indicator
long summer holiday or prolonged absence
from School
Increased emotional and psychological needs
e.g. withdrawal, depression or significant
behaviour change
Yes
No
Unknown
Comments
Girl avoiding physical exercise or requiring to
be excluded from PE lessons
Outcome: Please refer back to the pathway guidance
• Discuss assessment with Safeguarding Lead/Manager
• If the girl (or any other girls) is assessed to be at immediate risk the police must be contacted as a
matter of urgency
• If the girl (or any other girls) is assessed to be at risk of harm, refer to Children’s Social Care/MASH.
• Parents should not be informed at this stage
• If you are unsure of the level of risk please refer to Children’s Social Care/MASH for advice
Any additional actions:
Use simple language and ask
straight forward questions such as:
- “Did you go there for a “special
occasion”?”
- “Were you circumcised?”
- “Do you know anyone else who has
had the same thing happen to
them?”
- If the answer is yes, sensitively
question further.
Be direct, as indirect questions can
be confusing and may only serve to
compound any underlying
embarrassment or discomfort that
you or the girl may have.
Be supportive:
- “I am going to help you.”
- “Are you worried about..?”
27
Pathway 3 – Pregnant Woman who has undergone FGM
Indicator
Woman has undergone FGM herself
Woman asks for help
Woman already has daughters that have
undergone FGM
Woman is considered to be a vulnerable adult
(e.g. mental health concerns, living in a
domestic abuse household) and she is a victim
of FGM- so issues of capacity to consent need
to considered
Woman says FGM is integral to cultural or
religious identity
Woman’s nieces or siblings, in-laws or close
family member have undergone FGM
Mother has been infibulated following
previous delivery
Mother has requested infibulation following
girl birth
Parents have limited or no understanding of
harm of FGM or UK Law
Yes
No
Unknown
Comments
When talking about FGM
professionals should:
- Ensure that a female professional
is available to speak to if the woman
would prefer this.
- Make no assumptions.
- Give the individual time to talk and
be willing to listen.
- Create an opportunity for the
individual to disclose, seeing the
individual on their own in private.
- Be sensitive to the intimate nature
of the subject.
- Be sensitive to the fact that the
individual may be loyal to their
parents.
- Be non-judgemental (pointing out
the illegality and health risks of the
practice, but not blaming the
woman).
- Get accurate information about
the urgency of the situation if the
woman is at risk of being subjected
to the procedure.
- Take detailed notes.
- Ensure that FGM is recorded in the
woman’s healthcare record, as well
as details of any conversations.
Women comes from a community know to
practice FGM
Husband/partner comes from a community
known to practice FGM
28
Indicator
Yes
No
Unknown
Comments
Women has failed to attend follow-up FGM
clinic/FGM related appointment
Women is reluctant to undergo physical
examination
Grandmother or Female Family Elder who will
be involved in the care of the unborn/girl or is
influential in the family
Woman has limited integration in UK
Community
Woman’s husband/Partner/Other Family is
very dominant
Outcome: Please refer back to the pathway guidance
If there are any indicators that female siblings, relatives and unborn child or other daughters under the age of 18 are
at risk of FGM or suspected to have undergone FGM - please urgently refer to Pathway 1.
• If there is confirmation that any female siblings, relatives or daughters of the pregnant woman have
undergone FGM please urgently refer to Pathway 2.
Actions in relation to pregnant woman
• Consider any health and wellbeing requirements and refer to GP and/or maternity services
• Refer to adult social care if woman is assessed as vulnerable
When
talking
about FGM
Use
simple
language
and ask
professionals
should:
straight
forward
questions such as:
Ensureyou
thatbeen
a female
professional
- “Have
closed?”
available
speak to if the woman
-is“Were
youtocircumcised?”
this.cut down there?”
-would
“Haveprefer
you been
- Make
no
assumptions.
“When do you think FGM was
- Give the individual
time to
talkdid
and
performed?
Do you know
who
be willing to listen.
it?”
- Create
an opportunity
forabout
the
“What are
your thoughts
individual
to disclose, seeing the
it?”
individual on their own in private.
-Be
Bedirect,
sensitive
to the intimate
nature
as indirect
questions
can
of
subject.and may only serve to
be the
confusing
-compound
Be sensitive
the fact that the
anytounderlying
individual
may be
to theirthat
embarrassment
orloyal
discomfort
parents.
you or the woman may have.
- Be non-judgemental (pointing out
the
illegality
and remains,
health risks
If
any
confusion
askof the
practice,questions
but not blaming
leading
such as:the
woman).
Get accurate
information
about
- “Do
you experience
any pains
or
the urgencyduring
of theintercourse?”
situation if the
difficulties
is have
at riskany
of being
subjected
-woman
“Do you
problems
to the procedure.
passing
urine?”
- Take
detailed
“Do you
have notes.
any pelvic pain or
- Ensure that
FGM is recorded in the
menstrual
difficulties?”
healthcare
record, as well
-woman’s
“Have you
had any difficulties
in
as
details
of
any
conversations.
childbirth?”
Any additional actions:
29
Pathway 4 – Non-Pregnant Woman who has undergone FGM
Indicator
Woman asks for help
Woman already has daughters who have
undergone FGM
Woman’s nieces or siblings, in-laws or close
family member have undergone FGM
Woman says FGM is integral to cultural or
religious identity
Woman is considered to be a vulnerable
adult (e.g. mental health concerns, living in a
domestic abuse household) and she is a
victim of FGM therefore issues of capacity
need to be considered
Husband/Partner comes from a community
known to practice FGM
Women/family have limited/ no
understanding of harm of FGM or UK law
Yes
No
Unknown
Comments
When talking about FGM
professionals should:
- Ensure that a female professional
is available to speak to if the
woman would prefer this.
- Make no assumptions.
- Give the individual time to talk
and be willing to listen.
- Create an opportunity for the
individual to disclose, seeing the
individual on their own in private.
- Be sensitive to the intimate nature
of the subject.
- Be sensitive to the fact that the
woman may be loyal to her parents.
- Be non-judgemental (pointing out
the illegality and health risks of the
practice, but not blaming the
woman
- Get accurate information about
the urgency of the situation if the
woman is at risk of being subjected
to the procedure.
- Take detailed notes.
- Ensure that FGM is recorded in
the woman’s healthcare record, as
well as details of any conversations.
Women has failed to attend follow-up FGM
clinic/FGM related appointment
30
Indicator
Yes
No
Unknown
Comments
Woman’s husband/Partner/Other Family is
very dominant
Use simple language and ask
straight forward questions such as:
Grandmother or Female Family Elder e.g.
Grandmother, ‘Auntie’ is influential in the
family
- “Have you been closed?”
- “Were you circumcised?”
- “Have you been cut down there?”
- “When do you think FGM was
performed? Do you know who did
it?”
- “What are your thoughts about
it?”
Outcome: Please refer back to the pathway guidance
• If there are any indicators that female siblings, relatives and unborn girl or other daughters under the age of
18 are at risk of FGM or suspected to have undergone FGM - please urgently refer to Pathway 1.
• If there is confirmation that any female siblings, relatives or daughters of the woman have undergone FGM
please urgently refer to Pathway 2.
Actions in relation to pregnant woman
• Consider as appropriate referral to the police to notify a case of FGM
• Refer to adult social care if woman is assessed as vulnerable
• Following discussion and agreement of woman, refer to community groups or other services as appropriate
(see appendix A)
Any additional actions:
Be direct, as indirect questions can
be confusing and may only serve to
compound any underlying
embarrassment or discomfort that
you or the woman may have.
If any confusion remains, ask
leading questions such as:
- “Do you experience any pains or
difficulties during intercourse?”
- “Do you have any problems
passing urine?”
- “How long does it take to pass
urine?”
- “Do you have any pelvic pain or
menstrual difficulties?”
- “Have you had any difficulties in
childbirth?”
31
Appendix A: Local, regional and national help services:
Local
•
ACRE – FGM support in Reading:
http://www.acre-reading.org/
•
Trust House Reading:
http://trusthousereading.org/
•
Woman with Vision – FGM Survivors Group:
Jammie Koroma
Tel: 07737038629
[email protected]
Regional
•
Oxford Rose Clinic
http://oxfordagainstcutting.org/rose-community/
•
African Well Women’s Clinic
Guy’s & St. Thomas’s Hospital, 8th Floor – c/o Antenatal Clinic, Lambeth Palace Rd, London, SE1 7EH
Tel: 0207 188 6872
•
African Well Women’s Clinic - Antenatal Clinic
Central Middlesex Hospital, Acton Lane, Park Royal, London, NW10 7NS
•
African Well Women’s Clinic - Antenatal Clinic
Northwick Park & St. Mark’s Hospital, Watford Rd, Harrow, Middlesex, HA1 3UJ
•
African Well Women’s Clinic
Whittington Hospital, Level 5, Highgate Hill, London, N19 5NF
Tel: 0207 288 3482 ext. 5954
32
•
African Women’s Clinic
University College Hospital, Huntley St. London, WC1E 6DH
Tel: 0207 387 9300 ext. 2531
National
•
FGM National Clinical Group
UK-based charity dedicated to working with women who have been affected by FGM and other related difficulties.
http://www.fgmnationalgroup.org/
•
NSPCC FGM
NSPCC support available for FGM
https://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/female-genital-mutilation-fgm/
•
The Dahlia Project
Support group for women who have undergone FGM, in partnership with the Maya Centre and Manor Gardens, Islington.
http://www.mayacentre.org.uk/dahlia-project-survivors-fgm/
•
Forward UK
The Foundation for Women's Health, Research and Development (FORWARD) is the leading campaign and support charity providing
help with FGM, including counselling, referrals, information, materials and training. http://www.forwarduk.org.uk/
•
The Orchid Project
Charity advocating to end the silence and taboo around FGM and campaigning to end the practice.
http://www.orchidproject.org/
•
Women's Resource Centre
Charity supporting women's organisations to be more effective and sustainable. http://www.wrc.org.uk/
•
World Health Organisation (WHO)
The United Nations public health arm. Informing, monitoring and leading standards in international health policy.
http://www.fgmnationalgroup.org/
33