1. FGM
Making Research Count, University
of Bedfordshire, 27 June 2016

2. Menu of Topics
• What is FGM
• How many women and girls it affects worldwide, the UK
• Where is it practiced
• Implications for women’s health
• International Human Rights Framework
• UK Legal Framework including mandatory reporting and
FGM Protection Orders
• Complications in Preventing FGM
• Why there are no prosecutions
• How to identify women and girls at risk
• FGM Unit
• Other resources

3. WHAT IS FEMALE GENITAL MUTILATION ?
Female genital mutilation (FGM) or Female
Circumcision (FGC) comprises all procedures
involving partial or total removal of the
external female genitalia or other injury to the
female genital organs whether for cultural or
other non-therapeutic reasons
(WHO 1997)

4. HOW MANY WOMEN ARE AFFECTED?
• Worldwide, WHO estimates 137 million girls
and women have undergone some form of
FGM
• Two million girls a year are at risk of
undergoing some form of the procedure
• An estimated 137,000 women and girls living
with consequences of FGM in England and
Wales (in 2011).

5. TYPES
• Sunna—Removal of tip of clitoris, the prepuce
and/or part of clitoris
• Excision or Clitoridectomy—Removal of entire
clitoris and potentially portions of labia
minora and majora
• Infibulation (Pharaonic): Includes
clitoridectomy, removal of labia minora and
majora and sewing together of remaining
tissue

6. WHERE PRACTICED
• 29 African countries. Mainly in sub-Saharan
and Northeastern regions.
• Middle East—in Yemen, Oman
• Some instances amongst Muslim people
groups in India and Sri Lanka
• Until 1950’s was practiced in Western
countries such as the U.S. and France. Still
practiced in Western nations amongst
immigrant populations.

8. WHICH TYPE PRACTICED WHERE?
• Infibulation is practiced mostly in Horn of
Africa, including Egypt, Sudan, Somalia,
Ethiopia, Eritrea and sporadically in W. Africa,
e.g. Chad
• Clitoridectomy—Senegal, Kenya, in Western
countries until the 1950’s as treatment for
female homo-eroticism (masturbation).
• Still practiced in United States as a pediatric
surgery on infants with indeterminate
genitalia.

9. STATISTICS
COUNTRY FGM IS ILLEGAL PREVALANCE %
Somalia X 98
Egypt X 91
Guinea X 96
Sierra Leone 88
Djibouti X 93
Mali 89
Sudan (Northern) X 88
Eritrea X 89
Gambia 76
Ethiopia X 74
Burkina Faso X 76
Mauritania X 69
Liberia 66
Chad X 44
Guinea Bissau X 50
Cote d’Ivoire X 38
Kenya X 27
Senegal X 26
Central Africa Rep. X 24
Yemeni X 23
Nigeria X Some states 27
Benin X 13
Tanzania X 15
Togo X 4
Ghana X 4
Niger X 2
Cameroon 1
Uganda X 1
Iraq X Kurdistan region 8
FGM INTERNATIONALLY (WHO 1997)
ESTIMATES
100 AND 130 MILLION GIRLS AND
WOMEN
ABOUT 2 MILLION GIRLS AGED FROM A
FEW DAYS OLD ARE ESTIMATED TO BE AT
RISK.
ROUGHLY 6,000 FEMALE CHILDREN A DAY
ENGLAND AND WALES:
137,000 WOMEN AGED BETWEEN 15
AND 49
Around 65,000 Girls under 15 at
risk!
City University and Equality Now Research 2014
8 FGM Cases recorded at
Bedford Hospital - DoH April 2015

10. UK Situation
A 2015 study estimated that:
• In addition, approximately 10,000 girls aged under
15 who have migrated to England and Wales are
likely to have undergone FGM
• Approximately 60,000 girls aged 0 to 14 were born
in England and Wales to mothers who had
undergone FGM
• Approximately 103,000 women aged 15 to 49 and
approximately 24,000 women aged 50 and over
who have migrated to England and Wales are
living with the consequences of FGM.

11. UK Situation (2)
• Women who have undergone FGM do not only
live in urban centres in England and Wales: while
many affected women live in large cities where
migrant populations tend to be clustered, others
are scattered in rural areas
• No local authority area is likely to be free from
FGM entirely: in many areas, the estimated
prevalence is low, but there are still some women
who may be affected by FGM

12. UK Situation (3)
• London has the highest prevalence rate in England and Wales
with an estimated 2.1% of women affected by FGM
• Outside London, highest estimates were for Manchester,
Slough, Bristol, Leicester and Birmingham
Macfarlane, A. J. & Dorkenoo, E. (2015). Prevalence of Female
Genital Mutilation in England and Wales: National and local
estimates. London: City University London in association with
Equality Now. For link to the report go to:
http://openaccess.city.ac.uk/12382/9/FGM%20statistics%20final
%20report%2021%2007%2015%20released%20text%20correct
ed%20Jan%202016%2020%2001%2016.pdf

13. What are the consequences?
• Serious medical complications during childbirth
• Severe pain, both at the time and for many months
afterwards
• Chronic infections (including UTIs)
• Menstrual problems
• Damage to reproductive system
• Long-term emotional and mental health issues,
e.g. depression, anxiety psychosexual disorders
and self-harm
• Urine retention
• Death from haemorrhaging

14. Long-term Consequences-2
• Continual bleeding
• Recurrent urinary tract infections
• Vaginal Fistulae, Vesico, for young girls or women
• Scarring
• Infertility
• Dermoid Cysts
• Risk of HIV/AIDS infection

15. Historical Discourses: Moral Outrage versus
Cultural Relativism
• Widespread international attention came with
the publication of Fran Hosken’s book, The
Hoskens Report: Genital and Sexual
Mutilation of Females (1979)
• Tone is one of horror, judgment.
• Women from African countries are offended.
They feel patronized and belittled.

16. History of Public Policy Approaches to FGC
• FC/FGM first addressed 1979 by World Health
Organization
• Formation of the Inter-African Committee on Traditional
Practices Affecting the Health of Women and Children
(IAC) in 1984 by African women as a response to
paternalism from Western women.
• Creates reaction amongst some---response becomes
cultural relativity.

17. Human Rights Approach adopted as way to
break impasse
• Paralysis results for a season. Western women
don’t get involved in FGC
• FGC was first framed as a human rights
violation in 1980’s in order to break impasse.

18. Politics of Naming illustrates problem
• Do you call it female circumcision?
• Do you call it female genital mutilation?
• Do you call it female genital cutting?

19. Cultural relativity versus Western Moral
Outrage
– The problem is if we adopt cultural relativity, it is
actually conservative and supports status quo.
This is also racist. Ignores the fact that all
cultures are pluralistic and are contested from
the margins. There is constant struggle to define
the cultural identity of a people.
– The problem with moral outrage is the tendency
to impose our own cultural values and beliefs on
others as being universally applicable when they
are not. How do we decide what is universally
true and what isn’t?

20. Human Rights Approach
• 1990’s strengthens human rights approach to FGC:
-Committee on the Elimination of Discrimination Against
Women, (CEDAW) 1990
-1993 World Conference on Human Rights, Vienna
(violence against women)
-International Conference on Population and Development,
Cairo, 1994
-Fourth World Conference on Women, Beijing 1995

21. Gender Discrimination Under Human Rights
Laws
• To fall under human rights law, it must meet two criteria:
1. FGC/M must be a distinction based on sex
2. Must have the effect or purpose of impairing the equal enjoyment
of rights by women.
• FGC/M represses women’s independent sexuality, it controls women’s
sexuality and therefore carries strong message about subordinate role
of women and girls in society.
• FGM does fit within this definition of gender discrimination

22. Other Human Rights Laws
• Right to life and to physical integrity. One premise of FGC is that
women’s bodies are flawed and need correction. This practice doesn’t
respect their dignity and natural appearance.
• Violates women’s right to privacy as it seeks to intervene into her
sexuality
• When done without consent FGC violates the liberty of women and
girls. Therefore, it is a form of violence against women.
• It infringes on women’s right to health which is also a right given in
various human rights treaties

23. Human Rights Approach
• FGC is viewed as an act of violence against
women and girls
• It becomes viewed as act of gender
discrimination and therefore outlawed by
CEDAW
• It violates the physical integrity of women and
girls

24. FGM as a Violation of Human Rights
• Violation of women and girls’ right to health
• Violation of the rights of the child (Convention
on the Rights of the Child)

25. National Arena—Situation Varies
• Situation varies from country to country
• U.S. and U.K. have a law against it
• Sudan doesn’t have a law
• Kenya does, but it’s not always enforced.

26. FGM WORLD MAP

27. UK LEGAL FRAMEWORK: Prohibition
of Female Circumcision Act of 1985
• Incriminates persons who actually perform
the operation and any person that also aids,
abets, counsels or procures the service of such
an act
• Not unlawful if performed for necessary
(mental or physical health) surgery by a
registered medical practitioner
– Mental health does not include the belief that the
operation is necessary as part of custom or ritual

28. Prohibition of Female Circumcision Act
of 1985
• Maximum possible prison time is 5 years
• Consent is not an issue
• Jurisdiction is over England, Scotland, N.
Ireland and Wales
• There has been no prosecution under this Act
– 2 doctors (in 1993 and 2000) have been struck off
the medical register but not prosecuted

29. Female Genital Mutilation Act 2003
• Went into affect March 3rd, 2004
• Replaces the 1985 Act but basically retains the
provisions of the 1985 Act with a few
differences:
– Changes the title from Female Genital Cutting to
Female Genital Mutilation
– Specifically encompasses girls and women

30. Female Genital Mutilation Act 2003
– Extends the provisions of the Act to any offence of
FGM which takes place outside the UK on or by a
national or resident of the UK
– Increases the maximum possible prison time to 14
years
– Jurisdiction is over England, Wales and N. Ireland
• Scotland has yet to modify the 1985 Act but it is up for
consideration in this legislative program

31. Enforcement
• FGM is considered a form of child abuse
and is under the jurisdiction of Social
Services
• Children Act of 1989
– Part V Sections 46-48

32. Complications in Prevention
2 major differences from traditional forms of abuse:
• Parents believe it is in the best interests of the girl
– Deeply rooted in culture
– Non-recurring event
• Private matter
– Extremely difficult to find out and prevent
– No referrals to Social Services
• Last recourse is removal of the girl from her home

33. WHY NO PROSECUTION?
• CHILDREN UNLIKELY TO ‘TELL ON PARENTS’
• SEE NOTHING WRONG
• ONCE IN A LIFETIME EVENT
• PERSONAL AND INTIMATE – NOT OPENLY DISCUSSED
• HONOUR BASED
• VICTIMS TOO YOUNG TO REMEMBER
• LANGUAGE / IMMIGRATION ISSUES
• UNAWARE OF THE LAW
• LACK OF UNDERSTANDING OF FGM AND ITS IMPLICATIONS
BY PROFESSIONALS

34. FGM SERIOUS CRIMINAL ACT 2015
1. FGM PROTECTION ORDER – CIVIL LAW
 SURRENDER PASSPORT OR TRAVEL DOCUMENTS
 NOT TO AID, ABET, COUNSEL, PROCURE, ENCOURAGE
OR ASSIST
2. ALLOWS JUDGES TO:
 REMAND PEOPLE IN CUSTODY
 ORDER MANDATORY MEDICAL CHECKS
 INSTRUCT GIRLS AT RISK TO LIVE AT A PARTICULAR
ADDRESS
3. VICTIMS TO BE GIVEN LIFELONG ANONYMITY
4. MANDATORY RECORDING AND REPORTING

35. Mandatory Reporting Duty – Overview
Serious Crime Act 2015 amends the FGM Act 2003 to
introduce a new mandatory reporting duty which will
come into force on 31 October 2015.
Duty 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 duties to the
police

36. Mandatory Reporting Duty – Who?
• Regulated health and social care
professionals
• Qualified teachers employed or engaged
to carry out teaching work in schools and
other institutions
• In England and Wales
36

37. Mandatory Reporting Duty – When?
• Informed by a girl under 18 that an act of FGM has been
carried out on her; or
• Observe physical signs which appear to show that an act of
FGM has been carried out on a girl under 18.
• Relevant age is the girl’s age at the time of the
disclosure/identification of FGM.
• The duty does not apply in relation to at risk or suspected
cases or in cases where the woman is over 18
37

38. SOME INDICATORS THAT FGM HAS TAKEN PLACE
• Noticeable behaviour changes, particularly after
holidays
• Prolonged absence from school
• Ongoing unexplained health problems, e.g. stress,
UTIs, depression
• Not participating in PE or physical activities.
•A child who has undergone FGM should be seen as a
child in need and offered appropriate help
•Medical assessment and therapeutic services to be
discussed at a strategy meeting.

39. Mandatory Reporting Duty – How?
• A report to the police force area within which
the girl resides
• Recommend oral reports by calling 101
• Police will record the information and initiate
the multi-agency response
39

40. Mandatory Reporting Duty –
Breach
• Failure to comply with the duty will be
dealt with in accordance with the existing
performance procedures in place for each
profession
• FGM is child abuse, and employers and
the professional regulators are
expected to pay due regard to the
seriousness of breaches of the duty
40

41. Mandatory Reporting - FAQs
I don’t know much about FGM, what should I do to make sure I comply with the duty?
Wide range of information and guidance on FGM is available for all professionals, including a
free FGM e-learning package and multi-agency guidance on FGM.
The duty applies to my profession. If, while I am not at work, a girl discloses to me that she
has had FGM, does the duty apply?
No. The duty only applies to cases discovered by a relevant professional in the course of the
professional work. You should still follow your organisation’s safeguarding procedures.
I have made a report under the duty, but my local process is to make a full referral to social
services. Why do I have to report twice?
The legislation requires you to make a report to the police and does not require a second report to
social services.
I have a duty of confidence to my patients, doesn’t requiring a report to the police breach
this?
No. Complying with the duty does not breach any confidentiality requirement or other restriction
on disclosure which might otherwise apply, including any legal requirements.
41

42. CHILD HAS UNDERGONE FGM
Referral to
police,
Social
Services
Strategy
Meeting
Convened by Social
Services: Police, Child
Protection, person who
referred the case, ACCM
(UK) or other NGO or
Community member
Purpose:
1. To consider how, where and when the procedure
was performed and its implications for the child and
other children / family
2. Consider who are the best people to visit family
Visit
family
No children identified
as at risk, no further
action, follow up by
NGO to give
information
On going Concerns
Reconvene Strategy
meeting to plan
Intervention

43. CHILD AT RISK OF FGM
Referral to
police,
Social
Services
Strategy
Meeting
Convened by Social
Services: Police, Child
Protection, person who
referred the case, ACCM
(UK), other NGO
Purpose: 1. Establish if family informed
about implications of FGM
2.If not, provide the information and look at
ways that parental co-operation can be
achieved
3. Consider best people to visit family
Visit
Family
Agreement
reached – No
further action by
Social Services
or Police
No Agreement reached
Least intrusive legal action
to prevent FGM
If in danger – Emergency
Protection Order
Prohibition Steps Order –
Child Protection Case
Conference

44. Mandatory reporting is not a silver
bullet…..
Duty supported by raft of wider Government
activity:
• Effective leadership
• Building the evidence base
• The right legal framework
• Working with survivors and communities
• Partnership working
• Supporting frontline professionals
• Supporting victims
44

45. PREVENTION AND INTERVENTION
• Develop familiarity with the communities and prevalence rates.
• Exercise sensitivity and refrain from coming across with a
sense of superiority
• Give parents and young people information
• Interpreters (be wary and use ones that are trusted and not
part of the community where possible)
• Be wary of gatekeepers to the community, including family,
elders, religious leaders.
• Use appropriate resources and understand best how to make
referrals

46. INDICATIONS THAT A CHILD IS AT RISK
• The family comes from a community that is known for practicing
FGM
• Elderly women are present in the family
• In conversation a child mentions a special procedure or an
upcoming trip overseas
• Parent / Guardian requests permission or vaccinations for
overseas travel.
• If a woman has undergone FGM then the child protection
implications should be noted for any children you know she has.
(from ACCM UK)

47. There is much more to do…..
• Listening and incorporating survivors’
voices in policy and practice
• Turning policy into practice
• Measuring success (lack of data)
47

48. FGM Unit - Purpose
Coordinate efforts across Government
Provide outreach support to local areas
Act as a hub for effective practice, gathering and sharing
examples across local areas and professional groups.
Work closely with the voluntary and community sector, survivors
and professionals to develop policies and processes.
Work closely with the police, Border Force, CPS and the NSPCC
FGM helpline
The FGM Unit does not handle individual cases.

49. Available resources
FGM multi agency guidelines
www.gov.uk/government/publications/female-genital-mutilation-guidelines
FGM resource pack
www.gov.uk/government/publications/female-genital-mutilation-resource-pack/female-genital-
mutilation-resource-pack
Recognising or Preventing FGM training
www.fgmelearning.co.uk/
Procedural information for mandatory reporting
www.gov.uk/government/publications/mandatory-reporting-of-female-genital-mutilation-
procedural-information
NSPCC FGM Helpline
0800 028 3550/ fgmhelp@nspcc.org.uk
FGM Unit
FGMenquiries@homeoffice.gsi.gov.uk
49

50. Local Agencies
ACCM (UK)
1st FLOOR
3A WOBURN ROAD
BEDFORD
MK40 1EG
+44 (0)1234 356 910
+44 (0) 7712482568
Email: Info@accmuk.com
Website: www.accmuk.com

51. Local Agencies
Luton All Women’s Centre
The Spires
Suite 2
Adelaide Street
Luton
Bedfordshire
LU1 5BB
+44 (o)1582 416 783
support@lawc.org.uk
Website: www.lutonallwomenscentre.org.uk

52. “Multicultural sensitivity is no excuse for
moral blindness.”
Mike O’Brien, Solicitor-General and former Home Office Minister

53. MY CONTACT DETAILS
Nanci Hogan
Chief Executive
Sophia Transformations
nkhogan@sophiatransformations.com