A unique coalition of Royal Colleges, trade unions and Equality Now will today (4 November) launch the report, “Tackling FGM in the UK: Intercollegiate recommendations for identifying, recording & reporting” at the House of Commons. This ground-breaking report and collaboration recognises that implementing a comprehensive multi-agency action plan is urgently required to ensure that young girls at risk of undergoing female genital mutilation (FGM) are protected by the existing UK legal framework (which has been in place since 1985).
The report makes nine recommendations for tackling FGM in the UK and considers issues such as the lack of consistent data collection about FGM in the NHS. The recommendations suggest that babies, children and young girls suspected of going to be cut or presenting with FGM should be considered as potential victims of crime and referred to support services and the police, as appropriate. The report’s recommendations include:
1. Treat FGM as Child Abuse: FGM is a severe form of violence against women and girls. It is child abuse and must be integrated into all UK child safeguarding procedures in a systematic way.
2. Implement an awareness campaign: The Government should implement a national FGM awareness campaign, similar to previous domestic abuse and HIV campaigns.
3. Hold frontline professionals accountable: The NHS and local authorities should systematically measure the performance of frontline health professionals against agreed standards for addressing FGM and publish outcomes to enable effective benchmarking.
Other recommendations include: documenting and collecting information regarding FGM and sharing this information systematically; identifying girls at risk and referring them as part of child safeguarding obligation; and reporting cases of FGM.
According the charity Forward, in 2007 in the United Kingdom 66,000 women in England and Wales are estimated to have undergone FGM and over 24,000 girls under 15 are potentially at risk of undergoing the practise. This is despite the fact that the UK has specific legislation, which has banned FGM since 1985. The law, updated in 2003 (“005 in Scotland) to include an extra-territorial clause (extending rights beyond borders), carries severe penalties and offenders face a prison sentence of up to 14 years.
In the report’s foreword Keir Starmer QC, Director of Public Prosecutions, said: “Female Genital Mutilation (FGM) is a crime that affects some of the most vulnerable girls and women in our society. Through working together closely with the police, health and social care professionals and the third sector, we are now in a much better place to have a successful prosecution against those who perpetrate this practice. It is only a matter of time before this happens and this will send a very powerful message that FGM is a crime that will not be tolerated. …This important publication sets out recommendations aimed at those professionals who are key to bringing about the changes needed in the UK to help eradicate FGM.”
Public Health Minister Jane Ellison, who is hosting the report launch, said: “One of my priorities as Public Health Minister is to work towards eradicating female genital mutilation. Having supported this report during its development, I welcome its publication and the lead that the organisations involved, representing so many healthcare workers, are showing.
“Female genital mutilation is illegal and we have to both safeguard girls from this form of child abuse and address the longer-term health needs of those girls and women living with FGM. We are already working actively with the Health and Social Care Information Centre to look at how best the NHS could collect and share data and I am working hard, with colleagues across Government, to protect future generations of girls from this abhorrent practice.”
The Intercollegiate group is made up of the Royal College of Midwives, the Royal College of Nursing, Royal College of Obstetricians and Gynaecologists, Unite/Community Practitioners and Health Visitors Association, and Equality Now. Other supporters of the project are the Royal College of General Practitioners; Royal College of Paediatricians and Child Health, Royal College of Psychiatrists and the charity Daughters of Eve, as well as FGM survivors.
Commenting on the report, the Royal College of Midwives Chief Executive Cathy Warwick said: “I am pleased that the Royal Colleges, trade unions, NGOs and survivors have come together to call for strategic and coordinated action to tackle FGM. We cannot expect communities or girls and young women tackle this issue by themselves. FGM robs girls of their childhood and it is an abuse of their human rights. This is why we must work collaboratively to ensure that these recommendations, aligned to current policy frameworks, are implemented and monitored. I applaud the coalition for its hard work.
“FGM is a violation of children and women’s human rights, and there is a real need to raise awareness about the damage that FGM can do to young girls and women within the communities that practise it. We as midwives must advocate for young girls and take a lead on protecting and safeguarding the current generation.”
Efua Dorkenoo, OBE, Advocacy Director of FGM Programme, Equality Now, said: “The UK is well on its way to developing a 'joined-up' response to FGM, which will ensure that existing prevention and prosecution measures are properly implemented in a coordinated way. Recent work by key agencies such as the Crown Prosecution Service and the Met Police has been encouraging. However, we need to re-double our efforts to ensure that the right systems are institutionalised, that the correct data is gathered and shared and that every front-line professional knows what action they need to take to ensure that girls at risk of undergoing FGM are fully protected from the moment they are born”.
Dr David Richmond, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said: “FGM is violence against women and we must find ways to eradicate this harmful and unacceptable practice. When it is done on girls, it is a form of child abuse with many long-term consequences.
“It is the duty of all healthcare professionals to identify the girls whom they believe are at-risk and to share such information in good faith with the local safeguarding networks so these girls can be monitored and protected by social services. Such an approach follows the life-course model of health and social care that the RCOG advocates.”
Dr Deborah Hodes, Consultant Community Paediatrician from the Royal College of Paediatrics and Child Health, said: “Female genital mutilation has been illegal in the UK for more than 25 years. This report, which will be crucial in raising awareness of this issue within the medical profession and beyond, aims to end this form of violence against women and children forever.
“In the UK, there are women who come from countries where FGM is common. Many of their children, despite being born here, are at risk of having this procedure forced upon them.
“It is, therefore, crucial that all paediatricians have the confidence to talk to parents about the issue and the ability to recognise the signs and respond appropriately when the child is at risk. They must also understand which children are most vulnerable.
“A vulnerable child could come into contact with a paediatrician for any reason and in any setting. This guidance will be invaluable in supporting all healthcare professionals to protect the child.”
The Royal College of Nursing’s Director of Nursing Janet Davies said: “All health and social care professionals have a responsibility to do all they can to identify and prevent this abuse. This important guidance makes it clear that nurses, midwives and doctors must work with the police, teachers and social services when they have concerns.
“These intercollegiate recommendations will help create systems that will work to identify and report suspected cases of at risk girls, or where this abuse may have taken place. This is a growing problem in the UK, and it requires different agencies working together to try to eradicate FGM.
“We know nursing and midwifery staff want to play their part in protecting these vulnerable girls and women, and when implemented these recommendations will be a step in the right direction.”
Lead Professional Officer for Unite/Community Practitioners and Health Visitors Association Obi Amadi said: “We are really pleased to have been partners in this important work. This is ‘joined up thinking’ and we are all committed to acting together on this issue. FGM devastates the lives of girls and young women and needs to be stopped. This is an important project for health visitors because they need to get good information from midwives about FGM. This project is also about safeguarding vulnerable children and information about FGM should be collected sensitively and as a routine practice.
School nurses are with children during a key formative period in their lives and are advocates for children potentially impacted by FGM. An alert about FGM risk for a child should come with school handover. Above all, children should be listened to sensitively.”
The group also found that there are gaps in the responsiveness of the health and social care system in addressing FGM. There is minimal documentation of FGM in the health and social care system. There is no “joined up” work to support early identification of risks and a plan being put into place to support long-term prevention. Local and national child protection frameworks and healthcare professionals do not necessarily know how to go about identifying and referring girls who they suspect may be at risk to the appropriate agencies. Where girls are referred to social services, the issue may be dropped, as it is not deemed to meet the threshold for social service intervention.
In the absence of accountability on performance by local and health authorities on FGM, the system is failing girls at risk of FGM. A comprehensive system needs to be put into place to support early identification of risks of FGM and prevention, as well as referrals and reporting to the police, says the report. It also calls for health and social care agencies, education and the police to integrate FGM prevention into national and local strategies to safeguard children from FGM abuse. The report also highlights the lack of consistent data collection in the NHS on FGM, and an unco-ordinated approach to sharing information across the health, social care and education sectors. By acting together, the Intercollegiate group feels that the UK can work towards the elimination of FGM in future.
Two case studies will be available before and during the launch for interviews about their first person experience of FGM and views about the report. Please contact the RCM press office for further details.
To request a copy of the report contact the RCM Press Office and Communications Advisor Manuela Fernandes on 07703 321661 or 020 7312 3433; Gerald Chan, Director, Health Policy and Public Relations, (0)20 7772 6446; Brendan Wynne, 07593 300794
Notes to editors
About the Intercollegiate Group on FGM
Following the release of the CPS’ Action Plan in November 2012, the organisations involved in the Intercollegiate group took the initiative to consult with relevant stakeholders over the last six months. They have developed innovative recommendations to help health, social care and welfare and education professionals and relevant institutions to act to safeguard girls and women from FGM. They have specifically focussed on specific and tangible recommendations which they believe are achievable within current frameworks. These will be released under embargo 00:01 Monday November 4th, the day of the launch. The report’s recommendations will also demonstrate solidarity to raise awareness of FGM as another form of abuse and the need to intervene early to prevent FGM.
The report’s nine recommendations include:
1. Treat it as Child Abuse: FGM is a severe form of violence against women and girls. It is child abuse and must be integrated into all UK child safeguarding procedures in a systematic way.
2. Document and collect information: The NHS should document and collect information on FGM and its associated complications in a consistent and rigorous way.
3. Share that information systematically: The NHS should develop protocols for sharing information about girls at risk of – or girls who have already undergone – FGM with other health and social care agencies, the Department for Education and the police.
4. Empower frontline professionals: Develop the competence, knowledge and awareness of frontline health professionals to ensure prevention and protection of girls at risk of FGM. Also ensure that health professionals know how to provide quality care for girls and women who suffer complications of FGM.
5. Identify girls at risk and refer them as part of child safeguarding obligation: Health professionals should identify girls at risk of FGM as early as possible. All suspected cases should be referred as part of existing child safeguarding obligations. Sustained information and support should be given to families to protect girls at risk.
6. Report cases of FGM: All girls and women presenting with FGM within the NHS must be considered as potential victims of crime, and should be referred to the police and support services.
7. Hold frontline professionals accountable: The NHS and local authorities should systematically measure the performance of frontline health professionals against agreed standards for addressing FGM and publish outcomes to monitor the progress of implementing these recommendations.
8. Empower and support affected girls and young women (both those at risk and survivors): This should be a priority public health consideration; health and education professionals should work together to integrate FGM into prevention messages (especially those focused on avoiding harm, e.g. NSPCC ‘Pants’ Campaign, Personal, Social and Health Education, extracurricular activities for young people).
9. Implement awareness campaign: The government should implement a national public health and legal awareness publicity campaign on FGM, similar to previous domestic abuse and HIV campaigns.
There are no codes either in International Classification of Diseases (ICD) 10, which are hospital codes or GP codes, which are called Snowmed or Reed for data to be potentially collected. There is now an understanding for this data to be collected so women are being asked about FGM in the NHS.
The hash tag for the launch is #tacklingFGM
For background information about FGM and legislation, please visit the following sites:
FGM Act 2003
CPS Action Plan
Unite is Britain and Ireland’s largest trade union with 1.4 million members working across all sectors of the economy. The general secretary is Len McCluskey