3.8.2 Female Genital Mutilation

1. Local Information

1.1 Sheffield Female Genital Mutilation (FGM) Strategy (2018)

Click here to view Sheffield Female Genital Mutilation (FGM) Strategy (2018).

1.2 Sheffield Multi-Agency FGM Pathway (for Victims and Those at Risk)

Click here to view Sheffield Multi-Agency FGM Pathway (for Victims and Those at Risk).

Appendicies

Appendix A: PREGNANT WOMEN (to help you make a decision as to whether the unborn child (or other female children in the family) is/are at risk of FGM or whether the woman herself is at risk of further harm in relation to her FGM).

Appendix B: NON-PREGNANT ADULT WOMAN (over 18) (to help you make a decision as to whether any female children are at risk of FGM, whether there are other children in the family for whom a risk assessment  may be required or whether the woman herself is at risk of further harm in relation to her FGM).

Appendix C: CHILD / YOUNG ADULT (under 18 years old) (to help when considering whether a child is AT RISK OF FGM, or whether there are other children in the family for whom a risk assessment may be required).

Appendix D: CHILD / YOUNG ADULT (under 18 years old) (to help when considering whether a child HAS HAD FGM).

2. Additional National Information

2.1 Legal Position

With effect from 3 May 2015, the Female Genital Mutilation Act 2003 was amended by the Serious Crime Act 2015. The law was extended so that:

• A non-UK national who is 'habitually resident' in the UK and commits such an offence abroad can face a maximum penalty of 14 years imprisonment. It is also an offence to assist a non-UK resident to carry out FGM overseas on a girl who is habitually, rather than only permanently, resident in the UK. This follows a number of cases where victims were unable to get justice as FGM was committed by those not permanently residing in the UK;
• An offence was created of failing to protect a girl from the risk of FGM. Anyone convicted can face imprisonment for up to seven years and/or an unlimited fine;
• Anonymity for victims of FGM. Anyone identifying a victim can be subject to an unlimited fine.

2.2 Female Genital Mutilation Protection Orders

On 17 July 2015, Female Genital Mutilation Protection Orders came into force.

Female Genital Mutilation Protection Orders are obtained in the Family Court like Forced Marriage Protection Orders. If you are concerned that someone may be taken abroad for FGM you can apply for a Protection Order. 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.

2.3 NHS Actions

Since April 2014 NHS hospitals have been required to record:

• If a patient has had Female Genital Mutilation;
• If there is a family history of Female Genital Mutilation;
• If a Female Genital Mutilation-related procedure has been carried out on a patient.

Since September 2014 all acute hospitals have been required to report this data centrally to the Department of Health on a monthly basis.

2.4 NHS Data Sharing

Female Genital Mutilation Information Sharing (FGM- IS) is a national IT system that supports the early intervention and ongoing safeguarding of girls, under the age of 18, who have a family history of Female Genital Mutilation (FGM).

FGM-IS is a service that supports the sharing of FGM information, and allows authorised healthcare professionals and administrative staff throughout England to view information about girls with a family history of FGM, regardless of care setting.

A national alert instigated by NHS Digital enables health professionals to add a ‘standard’ alert to a child’s summary care record (SCR) if it is highlighted they are at risk of FGM. The FGM-IS tab sits alongside the CP-IS (child protection information sharing) tab on the patient information page of their summary care record.

There are FGM risk assessments for safeguarding pregnant women/a woman who has recently had a baby and children to help support decision making.

2.5 Mandatory Reporting Duty

On 31 October 2015, the 'mandatory reporting' duty for professionals working in the 'regulated professions' came into force. This requires them to notify the police if they discover that an act of FGM appears to have been carried out on a girl who is under 18 (either if they have visually confirmed it or it has been verbally disclosed by an affected girl). 'Regulated professionals' cover healthcare professionals, teachers and social care workers. The only exception to the duty is if the professional knows that another individual from their profession has already made a report - there is no requirement to make a second.

Government Guidance Mandatory Reporting of Female Genital Mutilation – Procedural Information provides that social workers should not under any circumstances examine a girl for signs of FGM.

For the purposes of the duty, the relevant age is the girl's age at the time of the disclosure or identification of FGM – it does not apply where a woman aged 18 or over discloses she had FGM when she was under 18.

The duty does not apply where there is merely a suspicion that a girl is at risk of undergoing FGM.

The duty only applies to cases directly disclosed by the victim: it does not apply where a disclosure is made by a third party such as a parent, guardian or sibling.

The Guidance states that complying with the duty "does not breach any confidentiality requirement or other restriction on disclosure which might otherwise apply."

A failure to report the discovery in the course of their work could result in a referral to the relevant professional body.

2.6 Referral and Assessment

• Any indication or concern that a child is at immediate risk of, or has undergone, female genital mutilation should result in a referral to Children's Social Care. Where a child is thought to be at risk of FGM, practitioners should be alert to the need to act quickly - before the child is abused through the FGM procedure in the UK or taken abroad to undergo the procedure;
• On receipt of a referral social care will convene a Strategy Meeting with a chair from the Safeguarding Children's Service. This must take place as soon as practicable (and in any case within two working days), and should involve representatives from the police, Children's Social Care, education practitioners, and health services; 
• The Strategy Meeting must first establish whether the parents or girl has had access to information about the harmful aspects of Female Genital Mutilation and the law in the UK. If not, they should be given appropriate information regarding the law and harmful consequences of FGM;
• Every attempt should be made to work with the parents on a voluntary basis to prevent the abuse, including the use of community organisations and / or community leaders to facilitate the work with parents / family. However the child's interest is always paramount;
• If no agreement is reached, the first priority is the protection of the child and the least intrusive legal action should be taken to ensure the child's safety;
• If the strategy meeting decides that the child is in immediate danger and the parents cannot satisfactorily guarantee that they will not proceed with it, then legal advice must be sought;
• Where a girl has already undergone FGM, a second Strategy Meeting should take place within ten working days of the referral. This meeting must evaluate the information collected in the enquiry and recommend whether a child protection conference is required;
• A girl who has already undergone FGM should not normally be subject to a Child Protection Conference or Plan unless additional child protection concerns exist. However, she should be offered counselling and medical help, and consideration should be given to any other female siblings at risk;
• All decisions or plans should be based on good quality assessments and be sensitive to the issues of race, culture, gender, religion and sexuality; and should avoid stigmatising the girl or woman affected, and the practicing community, as far as possible given the other principles above;
• Any interpreter should be appropriately trained in relation to Female Genital Mutilation and should not be a family member, not be known to the individual, and not be an individual with influence in the individual's community. This is because girls or women may feel embarrassed to discuss sensitive issues in front of such people and there is a risk that personal information may be passed on to others in their community and place them in danger;
• Information used in this document is from FORWARD, 2005.

2.7 Other Harmful Practices

Virginity testing and hymenoplasty can be precursors to child or forced marriage and other forms of family and/or community coercive behaviours, including physical and emotional control. The practices are degrading and intrusive. They can lead to extreme psychological trauma in the victim, and can provoke conditions including anxiety, depression and post-traumatic stress disorder. The practices have been linked to suicide and can be physically harmful.

Women and girls may themselves present to agencies requesting the procedures in an attempt to protect themselves from further harm and abuse, including shaming, disownment, physical abuse and possible honour-killings. Family and/or community members who are unaware of the change in law may also try to contact agencies seeking the procedures for their daughters and female relatives.

See Virginity Testing and Hymenoplasty: Multi-agency Guidance (DHSC) for good practice guidance and indicators that a woman or girl is at risk of or has been subjected to a virginity test and/or hymenoplasty.

It is important to find out if the woman or girl is in immediate danger. In an emergency, the police should be contacted without delay. If it is not an emergency but there is a concern that the individual is at risk, the organisation’s safeguarding procedures and any professional duties should be followed. This may involve a referral to social care services and/or the police should be made.

Virginity testing and hymenoplasty are forms of so called ‘honour-based’ abuse and violence against women and girls. Like forced marriage and female genital mutilation (FGM), the victims of these abuses are at risk of being subjected to further harm, whether that be psychological or physical. The same sensitivity and precautions apply as for other types of so called ‘honour’ based abuse.

Organisations should not involve families and community members in cases involving virginity testing and hymenoplasty, including trying to mediate with family or using a community member as an interpreter. Engaging with families and community members may increase risk of harm to the victim. The victim may be punished for seeking help and arrangements for procedures may be expedited.

The Health and Care Act 2022 has made it illegal to carry out, offer or aid and abet virginity testing or hymenoplasty in any part of the UK. It is also illegal for UK nationals and residents to do these things outside the UK.

In England and Wales and Northern Ireland, the offences will each carry a maximum penalty of a 5-year custodial sentence and/or an unlimited fine. There is a risk that women and girls may be taken abroad and subjected to virginity testing and hymenoplasty (as is often seen with so called ‘honour-based’ abuse offences, such as female genital mutilation or forced marriage). The offences, therefore, carry extra-territorial jurisdiction. This means that UK nationals and residents who carry out a virginity test or hymenoplasty outside the UK also commit an offence in the UK.

Breast flattening which is the painful and harmful practice of bringing a girl's breasts into contact with hard or heated objects (which may vary in nature but may include stones, belts, pestles and heated implements) to suppress or reverse the growth of breasts by destroying the tissue.

Breast flattening is often performed at first signs of puberty, usually by female family members professing to make a teenage girl look less womanly to avoid sexual interest, prevent pregnancy and rape, deter from sexual relationships outside marriage and dishonouring the family/community. Due to the type of instruments, force and lack of aftercare, there are significant physical and psychological consequences and risks related to this practice.

Breast flattening is a form of child abuse. See the CPS legal guidance on So-Called Honour-Based Abuse.

Further Information

Legislation, Statutory Guidance and Government Non-Statutory Guidance

Multi-Agency Statutory Guidance on Female Genital Mutilation (GOV.UK)

Female Genital Mutilation Resource Pack (Home Office) - including links to local organisations

FGM Protection Orders: Factsheet

Mandatory Reporting of Female Genital Mutilation – procedural information

Safeguarding Women and Girls at Risk of FGM – Guidance for Professionals (DHSC) – includes Pathway and Risk Assessment tools

Female Genital Mutilation CPS Guidelines

Virginity Testing and Hymenoplasty: Multi-agency Guidance (DHSC)

National Support Agencies

Good Practice Guidance

FGM Assessment Tool for Social Workers (National FGM Centre). It has two elements; Best Practice Guidance and an Online FGM Assessment Tool to help guide the assessment of cases where FGM is a concern.

NSPCC FGM helpline: 0800 028 3550

Female Genital Mutilation and its Management: Royal College of Obstetricians and Gynaecologists 2015

Useful Websites

National FGM Centre provides a range of guidance for all agencies including schools, health and social care

AFRUCA (Child Protection of African Children)

Forward (Foundation for Women's Health Research and Development)

NHS - FGM (including information on where to get support)