Female Genital Mutilation (FGM)

Did you know?

  • Female genital mutilation is a type of domestic violence because it is usually set up or carried out by family members
  • Although FGM is usually done to young girls, adult women are also at risk.
  • If you are a social worker or regulated health worker, you have a legal duty to report FGM
  • Recent research states that FGM cases increased from under 4million in 2015 to 4.3million in 2023. 

What is female genital mutilation?

Female genital mutilation (FGM) is a type of traditional harmful practice which aims to remove, injure or change a girl or woman’s genital organs (clitoris, labia and vagina).  It is sometimes called ‘cutting’, ‘female circumcision’ or ‘sunna’.  There are no health benefits to FGM. In fact, FGM can cause serious lifelong harm to women, even death. FGM is the leading cause of death in countries where it is practiced. 

FGM is a crime and a form of abuse.  Responding to it cannot be left to personal choice. 
Generally, FGM is a form of domestic violence because usually it is set up or carried out by members of the family.  

Signs to look out for:
The signs of FGM are often hidden and it can be very difficult to spot.  

Physical signs include:
•    pain, shock, bleeding and injury are common immediately after FGM
•    ongoing vaginal and pelvic infections
•    abnormal periods
•    long-term urine infections
•    infertility

Emotional signs include:
•    psychological damage
•    depression, anxiety and self-harm
•    low sex-drive
•    flashbacks during pregnancy and childbirth

Groups of women (especially with girls under the age of 15) travelling to certain foreign countries (such as Egypt and Somalia) may be a cause for concern.  Every year, girls are taken abroad so that FGM can be carried out in the summer holidays.  This gives them time to ‘heal’ before they return to school.  

Signs that this may be a risk are:
•    knowing that the family belongs to a community in which FGM is practised
•    signs that the family is preparing to take a girl on holiday, such as arranging  vaccinations or planning absence from school
•    the girl or woman says a special procedure/ceremony is going to take place.

Most at risk from FGM are girls and women from the following communities:

•    Kenyan, Somali, Sudanese, Sierra Leonean, Egyptian, Nigerian and Eritrea.  
•    Non-African communities that practice FGM include Yemeni, Afghani, Kurdish, Indonesian and Pakistani.

Mostly FGM is done to young girls.  But FGM is sometimes done to an adult woman before she gets married (in some cases a forced marriage) or during pregnancy.  FGM is also sometimes re-done after a woman gives birth. 

Why do traditional harmful practices happen?

FGM and other traditional harmful practices are carried out for cultural, religious and social reasons within families and communities.  Some communities believe FGM is an important part of preparing for adulthood and marriage.  FGM is often linked with beliefs about family ‘honour’.  Some communities mistakenly believe FGM is a religious requirement.  It is not. It can cause serious physical, mental and emotional harm to the victim.  

A recent interesting piece of research has linked FGM practice back to the slave trade suggesting that historically women and girls who had undergone FGM were given a higher price on the slave trade market as it confirmed their virginity and loyalty to the owner. Find out more about this research using this link. This practice has since then been adopted by non-slave trade populations to signity a woman's virginity in some cultures. 

What is the law on FGM?

Every girl and woman has the right to grow up free from the abuse and violation of FGM.  That’s why the government is strengthening the law to stop it.  
•    The Female Genital Mutilation Act (2004) makes it illegal to practice FGM in the UK or to take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in another country.  
•    FGM protection orders safeguard women and girls at risk of FGM.  
•    Teachers and regulated health and social care professionals are under a legal duty to report known cases of FGM in girls under 18 and of adults with care and support needs to the police via 101.  
•    It is also a criminal offence to fail to protect a girl or adult with care and support needs from the risk of FGM.  

Can a woman consent to FGM?

Young girls cannot consent to FGM.  But it is possible for an adult woman to give valid consent to FGM.  However, for consent to be valid is has to be 
•    Freely given (meaning that the consent must be given without anyone pressuring or influencing them)
•    Informed consent (meaning that the woman fully understands what the procedure involves, fully understands the risks and the short-term and long-term implications of the procedure)

Where a woman gives valid, freely-given informed consent to surgery to her genitalia for non-medical reasons, it is generally referred to as a clitorodectomy, labiaplasty or vaginoplasty, rather than FGM.

However, there are very strong cultural and societal pressures on woman in some communities to undergo FGM. Usually, it is the family that force or put huge pressure on a girl or woman to undergo FGM. In some cases, the pressures may not be obvious, but they may be so strongly embedded in the community that that the woman is almost certainly under some kind of duress or undue influence.  Duress and undue influence invalidate consent.  If consent is not completely freely given, it is not proper consent.  

Also, because FGM is often not openly discussed, it is difficult to ensure that a woman knew all the facts and had all the information about FGM before giving her permission to undergo the procedure.  If a woman does not understand the health and psychological risks in undergoing FGM, then she does not give informed consent.

Disabled women are at greater risk of any type of domestic violence.  Women with disabilities, health and mental health issues may be more easily pressured into FGM.  They may also not have the mental capacity to give valid consent.

What’s the procedure for concerns about FGM?

As FGM is a crime, the police will lead on these cases.  

The Multi-agency statutory guidance on FGM gives specific information on safeguarding adults with care and support needs.

•    First, check whether the woman at risk of FGM meets the definition of an Adult at Risk 
If the concerns relate to a girl under age 18, you must refer the case to the Children’s Services Contact Team (CSCT). Failure to do so may be a criminal offence.
•    If the woman is over 18 and has children, it is important to check whether the children are known to social services and whether there are any existing safeguarding arrangements in place.  If there is any indication the children may be at risk of FGM, make a referral to Children’s Social Services. 
o    Signpost the victim to floating support Domestic Violence services (Solace Women’s Aid) or clinics at the local hospital.  
•    Once concerns are raised about FGM, consider possible risks to other girls/women in the family and practising community. 
•    If you are worried that someone is a victim or is at risk of FGM, you must raise a safeguarding concern and discuss the case with your manager on the same working day. Failure to report and act on concerns about FGM of an adult with care and support needs may be a criminal offence. Where there are concerns about the woman’s immediate safety, an immediate core group meeting must be set up involving all other relevant agencies, the police, children’s social care, health services and any other agencies or voluntary organisations working with the woman. Consider involving health professionals with specific expertise on FGM from Whittington Hospital or University College London Hospital (UCLH).  
•    Consider whether to get legal advice – particularly if there are complex consent or mental capacity issues or the woman is at immediate risk of harm.  
•    Mental capacity should be assessed to establish if the person is able to make an informed decision
•    If there is evidence of any criminal act having taken place (for example, if the FGM took place in the UK or was performed or assisted by a British resident overseas), legal advice must be sought and a criminal investigation considered in the best interests of the victim
•    It is important to seek the views and wishes of the woman at risk.  An interpreter, if required, should have appropriate knowledge of FGM, the law and the harmful consequences.  The FGM clinics may be best placed to help source an appropriate interpreter.  The interpreter should be female and not be a family member.
•    If the perpetrators of the FGM are family members, the woman may be reluctant for the police to become involved. Even if she says she consents/consented to the FGM, seek legal advice on whether her consent was informed and validly given. Furthermore, a criminal investigation may be in the best interests of other women and girls in the family/community.
•    Where FGM has not yet taken place, but remains a risk, every attempt should be made to work with family members on a voluntary basis to prevent the FGM of the adult at risk taking place. 
•    If the core group meeting decides that a woman with care and support needs is in immediate danger of FGM, then a protection order should be sought legally.  The core group meeting should also consider whether there are other family/community members at risk.
•    Due to the interconnected nature of violence against women and girls, consideration should be given to whether the woman is the victim of other domestic abuse.  Explore these issues with the victim and if there are any other indications, complete a SafeLives Dash Risk Checklist to evaluate the domestic violence risks. Also consider whether a referral to the Islington Daily Safeguarding meeting is needed. Email marac@islington.gov.uk for a referral form. 
•    Consider referrals, with the woman’s consent, to appropriate medical help, counselling and support groups

Local FGM clinics run at Whittington Hospital and also at UCLH.  There contacts details are:

Whittington Hospital- This FGM clinic is midwifery led and gender specific. Both pregnant and non-pregnant women can access the clinic. The aim is to see women within two weeks of their referral. The clinic offers advice, counselling, ante natal care and assessment, de-infibulation, post-surgery and post natal follow up. Home visits are offered to women living in the borough of Islington and Haringey.
Kenwood Wing, Antenatal Clinic, Level 5, Highgate Hill, London N19 5NF
Contact: Tel: 0207 288 3482 or Mobile: 07825 034665

UCLH- FGM clinic and an affiliation with the urogynaecology service. 
Elizabeth Garrett Anderson Wing of UCLH, Lower Ground Floor, 25 Grafton Way, London, WC1E 6DB 
Contact:  Tel: 020 3447 5241/ 07944 241992 or email fgmsupport@uclh.nhs.uk

Useful Links

  1. NHS England FGM leaflet for professionals- https://www.england.nhs.uk/north/wp-content/uploads/sites/5/2016/01/fgm-hp-guide.pdf
  2. Royal College of Obstetricians and Gynaecologists- FGM and its management- https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg53/
  3. Crown Prosecution Service Prosecution guidance- https://www.cps.gov.uk/legal-guidance/female-genital-mutilation-prosecution-guidance  
  4. FGM linked to Red Sea slave trade route- Female genital mutilation linked to Red Sea slave trade route (telegraph.co.uk)
  5. FGM: resource pack- https://www.gov.uk/government/publications/female-genital-mutilation-resource-pack/female-genital-mutilation-resource-pack