Female Genital Mutilation

Female Genital Mutilation (FGM), also called female circumcision or ‘cutting’, is a procedure where the female genital organs are deliberately cut, injured or changed but there is no medical reason for this. It is a very traumatic and violent act and can cause harm in many ways. The practice can cause severe pain, and there may be immediate and/or long-term health consequences, including pain and infection, complications in menstruation, mental health problems, pain and difficulty having sex, urinary continence problems, difficulties in childbirth and/or death.

FGM is a deeply rooted practice, widely carried out among specific ethnic populations in Africa and parts of the Middle East and Asia. It serves as a complex form of social control of women's sexual and reproductive rights.

The age at which FGM is carried out varies enormously according to the community. The procedure may be carried out on new-born infants, during childhood or adolescence or just before marriage or during a woman's first pregnancy. There is no Biblical or Koranic justification for FGM and religious leaders from all faiths have spoken out against the practice.

Under the Female Genital Mutilation Act 2003, FGM is a criminal offence - it is child abuse and a form of violence against women and girls (VAWG) and should be treated as such.

Since 31 October 2015, when section 74 of the Serious Crime Act 2015 inserted new section 5B into the Female Genital Mutilation Act 2003, specified regulated professionals (including social workers) must report to the police any cases of female genital mutilation in girls under 18 that they come across in their work. The duty applies where the professional either:

• Is informed by the girl that an act of female genital mutilation has been carried out on her; or
• Observes physical signs that appear to show an act of female genital mutilation has carried out and has 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, and best practice is for reports to be made by the close of the next working day. A longer timeframe than the next working day may be appropriate in exceptional cases where, for example, a professional has concerns that a report to the police is likely to result in an immediate safeguarding risk to the child (or another child, e.g. a sibling) and considers that consultation with colleagues or other agencies is necessary prior to the report being made.

If foster carers have any concerns that FGM may have taken place or the child is at risk, they must contact the child’s social worker and their supervising social worker without delay.

FGM is child abuse and should be treated as such. Professionals should intervene to safeguard girls who may be at risk of FGM or who have been affected by it. The child’s social worker or you should report FGM as a safeguarding matter.

As soon as a girl is identified as at risk of FGM, information should be shared with other agencies (in accordance with local information sharing protocols and Information Sharing: Advice for Safeguarding Practitioners.

All concerns identified and actions agreed should be noted in the child's record.

The level of safeguarding intervention needed will depend on how imminent the risk of harm is. An appropriate course of action should be decided on a case-by-case basis, following a risk assessment, with expert input from all relevant agencies. A victim centred approach should be taken, based on a clear understanding of the needs and views of the child.  As the foster carer for the child you may be asked to contribute to any Section 47 child protection enquiry, which may include attendance at a child protection medical.

When a girl is at imminent risk, legal intervention will  be considered, including whether an FGM Protection Order (FGMPO) should be obtained.

Where there are concerns that FGM has taken place

Children's Social Care will liaise with Paediatric services where it is believed that FGM has already taken place to ensure that a Medical Assessment takes place, and the girl receives the care and support she needs.

National FGM Support Clinics have been established to offer a range of support services for women over 18 who have undergone FGM. Support for girls under 18 is available from a specialist paediatric service at University College London Hospitals (UCLH). UCLH can be contacted by email at UCLH.paediatricsafeguarding@nhs.net.

Support for children, young people and families is also available from the NSPCC.

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.

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

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

Female Genital Mutilation CPS Guidelines

National Support Agencies

Good Practice Guidance

NSPCC FGM helpline: 0800 028 3550

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.

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)