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FGM health services

FGM guidance for professionals

Female genital mutilation (FGM) is defined by the World Health Organization (WHO) as procedures that include the partial or total removal of the external female genital organs for cultural or other non-therapeutic reasons.

There are four main types of FGM:

  • Type 1 – clitoridectomy – removing part or all of the clitoris.
  • Type 2 – excision – removing part or all of the clitoris and the inner labia (lips that surround the vagina), with or without removal of the labia majora (larger outer lips).
  • Type 3 – infibulation – narrowing of the vaginal opening by creating a seal, formed by cutting and repositioning the labia.
  • Other harmful procedures to the female genitals, which include pricking, piercing, cutting, scraping and burning the area.

It is illegal in the UK to subject a girl or woman to FGM, or to assist a non-UK person in carrying out FGM overseas.

Professionals need to be aware of the possibility of FGM. The Department of Health has published FGM: multi-agency practice guidelines (PDF, 1.63MB), which include general information about FGM and the best practice to follow in all cases. 

Reporting FGM

Where FGM is identified in NHS patients, it is now mandatory to record this in the patient’s health record. Since September 2014, all acute trusts are required to provide a monthly report to the Department of Health on the number of patients who have had FGM or who have a family history of FGM. This information will be anonymous and no personal confidential data will be shared as a result of the information collection.

Health professionals in acute trusts should always update a patient record with whatever discussions or actions have been taken. If the patient has undergone FGM, referral to a specialist FGM clinic should always be considered. If you refer a patient to social services or the police, then this should also be recorded in the patient’s health record. If a patient is identified as being at risk of FGM, then this information must be shared with the GP and health visitor, as part of safeguarding actions.

Talking to women and young girls about FGM

It may be difficult for women to talk about the issue, and it's important to ask sensitively. There may be language barriers, and a trained interpreter may be required during the consultation. Some women may not understand the term FGM, but know about circumcision. Other ways of asking about it could be to use words such as "cut", "closed" or "open". Other important factors highlighted in the FGM: multi-agency practice guidelines (PDF, 1.63MB) are the following:

  • Women and girls may prefer to speak to a professional of the same gender.
  • They may not want to be seen by a professional from their own community.
  • Alerting the girl’s or woman’s family to the fact that she is disclosing information about FGM may place her at risk of harm.
  • Develop a safety and support plan in case they are seen by someone "hostile" at or near the department, venue or meeting place – e.g. prepare another reason why they are there.
  • If they insist on being accompanied during the interview – e.g. by a teacher or advocate – ensure that the accompanying person understands the full implications of confidentiality, especially with regard to the person’s family.
  • Do not assume that families from practising communities will want their girls and women to undergo FGM.

Deinfibulation or surgical 'reversal'

FGM increases the risk of the vagina tearing during delivery, which causes damage and can lead to heavy bleeding. It can also increase the risk of the baby becoming distressed or dying during, or just, after birth.

Deinfibulation or reversal surgery is best performed before pregnancy, or at least within the second trimester of pregnancy (between weeks 12 and 36).

Some women with FGM may be reluctant to undergo reversal until labour starts, because this may be normal practice in their country of origin. They may have not attended all antenatal checks or appointments due to fear about how they will be treated because of their FGM status. This can mean that women may arrive at hospital in labour, with FGM intact. A health professional or midwife may need to organise or perform deinfibulaiton quickly, especially if the baby shows signs of distress.

You can find more advice on how to deal with the reversal during labour on the Royal College of Nursing website.  

 

The FGM Prevention Programme

Updated guidance and clarification to support implementation. This factsheet outlines the requirements on all NHS staff in relation to female genital mutilation. Download the document and distribute it amongst your staff, at conferences and events, or use it for training purposes.

Recent developments

Consultation on statutory multi-agency practice guidance

A new consultation was launched, seeking views on the draft statutory multi-agency practice guidance on female genital mutilation (FGM) for frontline professionals in England and Wales. The consultation will run until September 30 2015. Email FGMconsultation@homeoffice.gsi.gov.uk or visit GOV.UK if you wish to respond to the consultation or find more information.

UK's progress since the Girl Summit 2014

Ministers have signed a cross-government declaration which outlines the UK’s progress to end FGM and forced marriage since the Girl Summit in 2014. Read the full declaration on GOV.UK.

Other useful resources

The following documents may help you when dealing with women and girls at risk of FGM:

e-Learning for Health

GOV.UK – FGM guidance, case studies and support materials for local authorities, professional services and specialist voluntary organisations

Barking, Havering and Redbridge University Hospitals NHS Trust

The British Medical Association

The Department of Health

The Department for Education

London safeguarding children board

NSPCC

Royal College of Obstetricians and Gynaecologists

Royal College of Midwives

Royal College of Nursing

Page last reviewed: 28/10/2014

Next review due: 28/10/2016

International day of zero tolerance for female genital mutilation 2016

Book your place for this national free event held on Monday February 8th 2016. The event is open to all those working in health, social work, police, education, community or affected by FGM. The aim is to share knowledge and discuss practical action, as people work together to safeguard women and girls.

Please not places are limited. If you require more information about the event, email info@profileproductions.co.uk or phone 020 3725 5840.

Mandatory reporting of female genital mutilation (FGM)

Specialist FGM midwife Juliet Albert speaks with Vanessa Lodge, national FGM prevention lead at NHS England, about the new female genital mutilation (FGM) mandatory reporting duty. They discuss what it means for health and social care professionals treating a girl who has disclosed she has had FGM, or has signs that appear to show she has had FGM.

Media last reviewed: 29/10/2015

Next review due: 29/10/2017

Vagina cup cakes

Watch more videos about FGM

The four videos below have been created to raise awareness about FGM

Dealing with child sexual exploitation

This guide provides professionals with advice and information about spotting and dealing with child sexual exploitation.