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3.20 Female Genital Mutilation


Contents

  1. Legal Status
  2. Cultural Underpinnings
  3. Types of Female Genital Mutilation
  4. Implications of Female Genital Mutilation for a Child's Health and Welfare
  5. Professional Response
  6. Identifying a Child who is at Risk of FGM or who may have been Subjected to FGM and Suffering Physical and Emotional Harm
  7. Responding to FGM: Immediate Concern about a Child at Risk of FGM or that may have undergone FGM - Referral to Children, Education and Families
  8. Responding to FGM: Non-immediate Concern about a Child – Referral to Multi-agency Consultation Meetings
  9. Responding to FGM: Women with FGM Presenting to Healthcare Professionals in Oxfordshire
  10. Monthly Multi-Agency FGM Consultation Meetings
  11. Reducing the Prevalence of Female Genital Mutilation


1. Legal Status

The World Health Organisation (WHO) defines female genital mutilation (FGM) as: "all procedures (not operations) which involve partial or total removal of the external female genitalia or injury to the female genital organs whether for cultural or other non-therapeutic reasons" (WHO, 1996).

It is illegal in the UK to subject a child to female genital mutilation or to take a child abroad to undergo FGM. In England, Wales and Northern Ireland all forms of FGM are illegal under the Female Genital Mutilation Act 2003 and in Scotland it is illegal under the Prohibition of FGM (Scotland) Act 2005.

The Serious Crime Act 2015 extends the jurisdiction of the 2003 Act. These changes mean that the 2003 Act can capture offences of FGM committed abroad by or (in the case of a section 3 offence) against those who are habitually resident in the UK irrespective of whether they are subject to immigration restrictions. Provided that the offence is committed at a time when the accused person and/or the victim is habitually resident in this country i.e. this is where they ordinarily live, even if they do not intend to live here indefinitely or they also live elsewhere. It does not cover a temporary visit or stay in a country not covered by the Act. The changes also prohibit the publication of any information that could lead to the identification of the victim. This covers all aspects of media including social media and will last for the lifetime of the alleged victim. A new offence of failing to protect a girl under 16 from FGM has been introduced. A person is liable for the offence if they are ‘responsible’ for the girl at the time when the offence is committed and this covers someone who has ‘parental responsibility’ and has ‘frequent contact’ and any adult who has assumed responsibility for caring for the girl in the manner of a parent. The Act also brought in FGM Protection Orders which can be obtained in the Family Court and can have very flexible terms according to the circumstances. From October 2015 the new duty for professionals working in the ‘regulated professions’ to notify the police if they discover that an act of FGM appears to have been carried out on a girl aged under 18 will come into force. This will cover healthcare professionals, teachers and social care workers. Failure to report could result in a referral to their professional body.

The rights of women and girls are enshrined by various universal and regional instruments including the Universal Declaration of Human Rights, the United Nations Convention on the Elimination of all Forms of Discrimination Against women, the Convention on the Rights of the Child, the African Charter on Human and Peoples’ Rights and Protocol to the African Charter on Human and Peoples’ Rights on the rights of women in Africa. All these documents highlight the right for girls and women to live free from gender discrimination, free from torture, to live in dignity and with bodily integrity.

A child for whom FGM is planned is at risk of Significant Harm through physical abuse and emotional abuse, which is categorised by some also as sexual abuse. See Recognition of Significant Harm - Definitions and Signs of Abuse Guidance.

Significant Harm is defined as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.


2. Cultural Underpinnings

Female genital mutilation (FGM) is a complex issue. Despite the harm it causes, many women from FGM practising communities consider FGM normal to protect their cultural identity.

Although FGM is practised by secular communities, it is most often claimed to be carried out in accordance with religious beliefs. However, neither the Bible nor the Koran supports the practice of FGM. In addition to giving religious reasons for subjecting their daughters to FGM, parents say they are acting in a child's best interests because it:

  • Brings status and respect to the girl;
  • Preserves a girl's virginity / chastity;
  • Is a rite of passage;
  • Gives a girl social acceptance, especially for marriage;
  • Upholds the family honour;
  • Helps girls and women to be clean and hygienic.

The age at which girls are subjected to female genital mutilation varies greatly, from shortly after birth to any time up to adulthood. The average age is 10 to 12 years.


3. Types of Female Genital Mutilation

Female Genital Mutilation and other terms (see glossary) has been classified by the WHO into four types:

  • Type 1: Clitoridectomy

    Excision of the prepuce with or without excision of part or all of the clitoris.

  • Type 2: Excision

    Excision of the clitoris with partial or total excision of the labia minora (small lips which cover and protect the opening of the vagina and the urinary opening). After the healing process has taken place, scar tissue forms to cover the upper part of the vulva region.

  • Type 3: Infibulation (also called Pharaonic Circumcision)

    This is the most severe form of female genital mutilation. Infibulation often (but not always) involves the complete removal of the clitoris, together with the labia minora and at least the anterior two-thirds and often the whole of the medial part of the labia majora (the outer lips of the genitals). The two sides of the vulva are then sewn together with silk, catgut sutures, or thorns leaving only a very small opening to allow for the passage of urine and menstrual flow. This opening can be  preserved during healing by insertion of a foreign body.

  • Type 4: Unclassified

    This includes all other procedures on the female genitalia including pricking, piercing or incising of the clitoris and or labia; stretching of the clitoris and or labia; cauterisation by burning of the clitoris and surrounding tissues; scraping of the tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts); introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purposes of tightening or narrowing it; and any other procedure that falls under the definition of female genital mutilation given above.


4. Implications of Female Genital Mutilation for a Child's Health and Welfare

The health implications for a child of the FGM procedure can be severe to fatal, depending on the type of FGM carried out.

As with all forms of child abuse or trauma, the impact of FGM on a child will depend upon such factors as:

  • The severity and nature of the violence;
  • The individual child’s innate resilience;
  • The warmth and support the child receives in their relationship with their parent/s, siblings and other family members;
  • The nature and length of the child’s wider relationships and social networks;
  • Previous or subsequent traumas experienced by the child;
  • Particular characteristics of the child’s gender, ethnic origin, age, (dis)ability, socio-economic and cultural background.

Short term implications for a child’s health and welfare

Short-term health implications can include: 

  • Severe pain;
  • Emotional and psychological shock (exacerbated by having to reconcile being subjected to the trauma by loving parents, extended family and friends); 
  • Haemorrhage;
  • Wound infections including Tetanus and blood borne viruses (including HIV and Hepatitis B and C);
  • Urinary retention;
  • Injury to adjacent tissues;
  • Fracture or dislocation as a result of restraint;
  • Damage to other organs;
  • Death.

Long term implications for a girl or woman’s health and welfare

The longer term implications for women who have been subject to FGM Types 1 and 2 are likely to be related to the trauma of the actual procedure. Nevertheless, analysis of World Health Organisation data has shown that as compared to women who have not undergone FGM, women who had been subject to any type of FGM showed an increase in complications in childbirth, worsening with Type 3. Therefore, although Type 3 creates most difficulties, professionals should respond proactively for all FGM types.

The health problems caused by FGM Type 3 are severe – urinary problems, difficulty with menstruation, pain during sex, lack of pleasurable sensation, psychological problems, infertility, vaginal infections, specific problems during pregnancy and childbirth, including flashbacks.

Women with FGM Type 3 require special care during pregnancy and childbirth.

The long term health implications of FGM include:

  • Chronic vaginal  and pelvic infections;
  • Difficulties in menstruation;
  • Difficulties in passing urine and chronic urine infections;
  • Renal impairment and possible renal failure;
  • Damage to the reproductive system including infertility;
  • Infibulation cysts, neuromas and keloid scar formation;
  • Complications in pregnancy and delay in the second stage of childbirth;
  • Maternal or foetal death;
  • Psychological damage; including a number of mental health and psychosexual problems including depression, anxiety, and sexual dysfunction;
  • Increased risk of HIV and other sexually transmitted infections.

Mental health problems

In FGM practising communities, the procedure is generally performed on pre-pubescent and adolescent girls usually without anaesthetics and with instruments such as razor blades. Case histories and personal accounts from women note that FGM is an extremely traumatic experience for girls and women that stays with them for the rest of their lives.

Young women who have received psychological counselling in the UK, reported feelings of betrayal by parents, incompleteness, regret and anger [2]. It is possible that as young women become more informed about FGM and/or cross the threshold from traditional Africa to the modern sector this problem may be more frequently identified [3]. There is increasing awareness of the severe psychological consequences of FGM for girls and women which become evident in mental health problems.

The results from research [4] in practicing African communities are that women who have undergone FGM have the same levels of Post Traumatic Stress Disorder as adults who have been subject to early childhood abuse. Also that the majority of the women (80%) suffer from affective (mood) or anxiety disorders.

The fact that FGM is ‘culturally embedded’ in a girl or woman’s community appears not to protect her against the development of Post Traumatic Stress Disorder and other psychiatric disorders.

[2] Haseena Lockhat, 2004, ‘Female Genital Mutilation: Treating the Tears’, London: Middlesex University Press

[3] Excised girls requiring psychological counselling was highlighted by women’s organization attending a recent Equality Now ‘Annual Meeting for Grassroots Activism to End Female Genital Mutilation’ which took place from the 20-22 October 2005 in Nairobi, Kenya.

[4] Behrendt, A. et al, 2005, ‘Posttraumatic Stress Disorder and Memory Problems after Female Genital Mutilation’, Am J Psychiatry 162:1000-1002, May


5. Professional Response

There are three circumstances relating to FGM which require identification, assessment and possible intervention.

  • Where a child is at risk of FGM;
  • Where a child has been abused through FGM;
  • Where a (prospective) mother has undergone FGM.

Professionals and volunteers in most agencies have little or no experience of dealing with female genital mutilation. Coming across FGM for the first time they can feel shocked, upset, helpless and unsure of how to respond appropriately to ensure that a child, and/or a mother, is protected from harm or further harm.

The appropriate response to FGM is to follow usual child protection procedures to ensure:

  • Immediate protection and support for the child/ren; and
  • That the practice is not perpetuated.

An appropriate response to a child suspected of having undergone FGM as well as a child at risk of undergoing FGM could include:

  • Arranging for an interpreter if this is necessary and appropriate;
  • Creating an opportunity for the child to disclose, seeing the child on their own;
  • Using simple language and asking straightforward questions;
  • Using terminology that the child will understand e.g. the child is unlikely to view the procedure as abusive;
  • Being sensitive to the fact that the child will be loyal to their parents;
  • Giving the child time to talk;
  • Getting accurate information about the urgency of the situation, if the child is at risk of being subjected to the procedure;
  • Giving the message that the child can come back to you again.

An appropriate response by professionals who encounter a girl or woman who has undergone FGM includes:

  • Arranging for a professional interpreter and not agreeing to friends/family members interpreting on their behalf;
  • Being sensitive to the intimate nature of the subject;
  • Making no assumptions;
  • Asking straightforward questions;
  • Being willing to listen;
  • Being non-judgemental (condemning the practice, but not blaming the girl/woman);
  • Understanding how she may feel in terms of language barriers, culture shock, that she, her partner, her family are being judged;
  • Giving a clear explanation that FGM is illegal and that the law can be used to help the family avoid FGM if/when they have daughters.

From October 2015 the new duty for professionals working in the ‘regulated professions’ 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 will come into force. This covers healthcare professionals, teachers and social care workers. A failure to report could result in a referral to their professional body.

Oxfordshire’s health visitors have developed guidance to assist them in asking mothers about FGM: ‘Health Visitors Guidance: 3 Key Questions for Interviewing Women to Discuss FGM’. This is ‘work in progress’ and not based on evaluation or national guidance. The guidance will be reviewed and developed in the light of practice experience.


6. Identifying a Child who is at Risk of FGM or who may have been Subjected to FGM and Suffering Physical and Emotional Harm

The Oxfordshire Safeguarding Children Board has approved a screening tool (see FGM Screening Tool) for FGM to assist professionals in identifying children at risk of being abused through FGM, or children who may have been subjected to FGM. This is kept under review and developed as knowledge and understanding of the risk factors and symptoms in different practising communities, increase in the UK.

Statutory Department for Education guidance ‘Keeping Children Safe in Education’ places a duty on teachers and educational staff to be alert to the signs and symptoms of FGM and implement child protection procedures, where they are concerned.

Indications that FGM may be about to take place include:

  • The family comes from a community that is known to practise FGM or have limited level of integration within UK community;

  • The family indicate that there are strong levels of influence held by elders and/or elders are involved in bringing up female children;

  • If a female family elder is present, particularly when she is visiting from a country of origin, and taking a more active / influential role in the family;

  • A child may talk about a long holiday to her country of origin or another country where the practice is prevalent, including African countries and the Middle East;
  • A child may visit a travel clinic, or equivalent, for vaccinations or anti-malarials in preparation for a trip abroad;
  • A child may confide to a professional that she is to have a 'special procedure' or to attend a special occasion;
  • A child may request help from a teacher or another adult;
  • Any female child born to a woman who has been subjected to FGM must be considered to be at risk, as must other female children in the extended family (see Section 9, Responding to FGM: Women with FGM Presenting to Healthcare Professionals in Oxfordshire) - the role of healthcare professionals Any female child who has a sister who has already have undergone FGM must be considered to be at risk, as must other female children in the extended family;
  • Repeated failure to attend or engage with health and welfare services or the mother of a girl is very reluctant to undergo genital examination;
  • Where a girl from a practising community is withdrawn from Sex and Relationship Education they  may be at risk from  their parents wishing to keep them uninformed about their body and rights.

Teachers, other school staff, volunteers and members of community groups may become aware that a child is at risk of FGM through a parent/other adult, a child or other children disclosing that:

  • The procedure is being planned;
  • An older child in the family has already undergone FGM;
  • The child has difficulty walking, sitting or standing and may appear to be uncomfortable.

School nurses are in a particularly good position to identify FGM or receive a disclosure about it.

A professional, volunteer or staff member who has information or suspicions that a child is at risk of FGM should use the FGM screening tool to record their concerns and consult with their agency or organisation’s designated safeguarding lead (if they have one) and should make an immediate referral to Children’s Social Care if there are indicators that FGM is about to take place.

If the designated safeguarding lead, a manager or senior officer, is not immediately available, the referral should not be delayed as multi-agency safeguarding intervention needs to happen quickly.

If there is a concern about one child, consideration must be given to whether siblings are at similar risk. Once concerns are raised about FGM there should also be consideration of possible risk to other children in the practicing community.

Indications that FGM may have already taken place include:

  • A child may spend long periods of time away from the classroom during the day with bladder or menstrual problems if she has undergone Type 3 FGM;
  • A prolonged absence from school with noticeable behaviour changes on the girl's return could be an indication that a girl has recently undergone FGM;
  • A child may present abrupt or uncharacteristic behavioural changes indicating emotional distress or psychological difficulties (e.g. withdrawal, depression etc.);
  • A child requiring to be excused from physical exercise lessons without the support of her GP;
  • A child may ask for help.

Teachers, other school staff, volunteers and members of community groups may become aware that a child has been subjected to FGM through:

  • A child presenting with the signs and symptoms described above;
  • A parent/other adult, a child or other children disclosing that the child has been subjected to FGM.

A professional, volunteer or community group member who has information or suspicions that a child has been subjected to FGM should use the FGM screening tool to record their concerns and consult with their agency or group’s designated safeguarding lead (if they have one).

If the child appears to be in acute physical and/or emotional distress, they should make an immediate referral to Children’s Social Care and to the local Health Service.

If there is a concern about one child, the child’s siblings and the children in the extended family, should be considered to be at risk.

Once concerns are raised about FGM in relation to one child/family there should also be consideration of possible risk to other children in the practicing community.


7. Responding to FGM: Immediate Concern about a Child at Risk of FGM or that may have undergone FGM - Referral to Children, Education and Families

Police, Children’s Social Care and Health trusts have identified operational leads to work together when individual children or women with FGM are referred. The operational leads aim to grow their experience and expertise in tackling FGM, so that they can act as consultants on the issue for their colleagues and inform future practice guidance.

If a professional suspects that a child may be at risk of FGM, the FGM Screening Tool should be used to identify the relevant risk factors and record the evidence behind the concerns. Any information or concern that a child is at immediate risk of, or has undergone, female genital mutilation (FGM) should result in a child protection referral to Children’s Social Care in line with the Referrals (including Referrals Pathway) Procedure.

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 FGM in the UK or taken abroad to undergo the procedure.

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. This was the first stage of a wider ranging programme of work in development to improve the way in which the NHS will respond to the health needs of girls and women who have suffered Female Genital Mutilation and actively support prevention.

A midwife/obstetrician/gynaecologist/General Practitioner may become aware that Female Genital Mutilation has occurred when treating a female patient. This should trigger concern for other females in the household.

For further information, see Information Standards Board for Health and Social Care, Female Genital Mutilation Prevalence Dataset Standard Specification.

On receipt of a referral, a Strategy Discussion/Meeting must be convened within two working days, and should involve representatives from the Police, Children’s Social Care, LA Legal Dept, Education, Health and voluntary services.

Professionals involved in the strategy discussion, should consult with their representative FGM operational lead, as a minimum measure. Where working arrangements permit, consideration should be given to the FGM operational leads taking the case, or attending the strategy discussion in an advisory role.

Consideration should also be given to inviting health providers or voluntary organisations with specific expertise (e.g. FGM, relevant cultural knowledge).

The Strategy Discussion/Meeting will lead to one or more of the following:

  • A child protection enquiry and assessment of the child’s needs;
  • Police action to prevent or prosecute a crime;
  • A plan to initiate legal action to protect the child;
  • A child protection conference and plan;
  • Further assessment and monitoring or preventative work;
  • An offer of  support or counselling by Health professionals;
  • An offer of a referral to a relevant BME community organisation which will offer services, befriending and/or support to reduce the risk of FGM being undertaken with the baby/child and other female family members;
  • A Child In Need Plan;
  • No further action.

Every attempt should be made to work with parents on a voluntary basis to prevent the abuse. It is the duty of the investigating team to look at every possible way that parental cooperation can be achieved, 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 the Child Protection Enquiry indicates that the child continues to be at risk of FGM, the first priority is protection of the child and the least intrusive legal action should be taken to ensure the child's safety.

If the Strategy Discussion/Meeting decides that the child is in immediate danger of the procedure being undertaken and parents cannot satisfactorily guarantee that they will not proceed with it, then an appropriate legal order should be sought.

Where FGM has been practised, the police child abuse investigation unit (CAIU) will take a lead role in the investigation of this serious crime, working to common joint investigative practices and in line with strategy agreements.

If the child has already undergone FGM, the Strategy Discussion/Meeting will need to consider carefully whether to continue enquiries or whether to assess the need for support services. If any legal action is being considered, legal advice must be sought.

A Child Protection Conference should be considered necessary if there are unresolved child protection issues once the initial investigation and assessment have been completed.


8. Responding to FGM: Non-immediate Concern about a Child – Referral to Multi-agency Consultation Meetings

If a professional suspects that a child may be at risk of FGM, the FGM Screening Tool should be used to identify the relevant risk factors and record the evidence behind the concerns.

Having completed the screening tool, if the risks do not appear to be immediate, or if the professional is uncertain as to the level of risk, they should consult with their designated safeguarding lead/FGM lead and decide whether the risk could be further clarified by bringing the case for discussion to the monthly multi-agency FGM consultation meeting (See Section 10, Monthly Multi-Agency FGM Consultation Meetings).

Health visitors and school nurses have a special interest group for FGM at which anonymised cases may be discussed. This group may advise a HV or SN to bring a case to the multi-agency consultation meeting to clarify the level of risk and ensure appropriate actions are taken.


9. Responding to FGM: Women with FGM Presenting to Healthcare Professionals in Oxfordshire

Any professional in contact with members of the public may meet women or young people with FGM who are seeking advice or help. In this circumstance, the professional or volunteer should assist the woman/young person to make contact with a healthcare professional. This may not be straightforward, as some people who are recent arrivals to the UK may not be automatically able to access GP services, depending on their legal status.

Healthcare professionals in GP surgeries, maternity services, gynaecology, urology, mental health, family planning and sexual health clinics are the most likely to encounter an adult woman or a young person (hereafter all referred to as ‘women’) who has been subjected to FGM in her childhood. However, any health professional could come into contact with victims. Health professionals encountering a woman who has undergone FGM should be alert to the risk of FGM in relation to her:

  • Immediate and long term physical, psychological and psycho-sexual health;
  • Daughters or daughters she may have now and in the future;
  • Younger siblings;
  • Female extended family members.

All women who have undergone FGM (and their boyfriends / partners or husbands) must be given information and advice about the harmful effects of FGM. Within key clinical services (including maternity/gynaecology, paediatrics, urology, sexual health and emergency medicine) there are named contacts/leads for FGM. Healthcare professionals may wish to seek support from their named lead for FGM for the consultation. 

All women with FGM should be offered referral to the specialist FGM clinic (the Oxford Rose Clinic). 

Depending on the community of origin, FGM can be undertaken with girls from babies to 18yrs. It is important to ascertain how old the woman was when FGM was performed and where this was carried out as it is possible that a crime has taken place. Women and their partners/husbands/family should be counselled that to aid, abet or procure FGM in the UK or to remove a girl/woman to another country so that FGM may be performed is illegal. 

A daughter born to a woman who has undergone any form of FGM should be recognised to be at potential risk in the future. The Oxfordshire Safeguarding Children Board has approved a screening tool (see FGM Screening Tool) for assessing onward risk to unborn or existing children of women with FGM. This is kept under review and developed as knowledge and understanding of the risk factors and symptoms in different practising communities, increase in the UK. This screening includes information-gathering about the woman’s/partner’s views on FGM, their cultural background, whether FGM is practised in the wider family, and understanding of the law relating to FGM in the UK. Whether or not a woman with FGM accepts referral to the Oxford Rose Clinic, this screening tool should be completed by the healthcare professional seeing the woman. This information should be shared with the FGM lead in that clinical area/service to enable submission to the monthly multi-agency consultation meeting (see below) and with the woman’s GP and if relevant, health visitor or school health nurse.  

Specialist FGM Clinic: the Oxford Rose Clinic

Pregnant and non-pregnant women in Oxfordshire who have undergone FGM can be referred to a specialist FGM clinic which is held monthly at the JR Hospital in Oxford and led by one of the consultant obstetricians. The key aims of this multidisciplinary service are to help women who suffer consequences of FGM, to raise awareness of the legal and safeguarding issues around FGM with the women and to protect female children from FGM. The service also offers a deinfibulation service for those women who have experienced Type 3 FGM, the most severe form of FGM. 

Given that FGM may have implications for safe childbirth and the potential safeguarding issues around protection of the unborn and existing female children, it is recommended that all pregnant women identified as having FGM are referred to this clinic. 

Information relating to the consultation is shared with the woman’s consent with her GP, and where relevant, her community midwife, health visitor and public health midwife. The woman is made aware that her identifying data will only be shared without her consent if there is a risk of significant harm to her child.  Information regarding women with FGM is presented in an anonymised manner at the monthly multi-agency consultation meeting (see below) in which a team of Healthcare and Children’s Social Care professionals assess and review the presenting risks, using the FGM screening tool for assessing onward risk of FGM unborn/existing girls in the household, and decide whether further actions are necessary. 

With regards to pregnant women who have undergone FGM, the midwife completing the red book (child’s health record) should write under section pertaining to family history that “the child is from a culture where FGM/C is prevalent”. On discharge from hospital, the midwife/public health midwife is responsible for handover of this information to the woman’s health visitor.


10. Monthly Multi-Agency FGM Consultation Meetings

Anonymised, also known as ‘no names’, consultations are case discussions in which the personal details of the child or parents are undisclosed. They provide the opportunity for professionals to discuss and assess the risk factors in the case (using the FGM Screening Tool) without the permission of the subject and come to a consensus about the appropriate course of action and whether there are safeguarding concerns which would justify information-sharing without parental consent. The range of outcomes include:

  • A practitioner offering further advice, guidance or services, including on-going preventative work;
  • A period of further assessment or monitoring;
  • A named referral to Children’s Social Care as there are immediate child safeguarding concerns (see below);
  • No further action.

At present, consultations take place at a monthly multi-agency FGM consultation meeting held in the JR Hospital and is attended by the hospital social worker, senior children’s social care practitioner, consultant obstetrician, consultant paediatrician and public health midwife. Consultations are numbered for reference and are forwarded to the Children and Families Assessment Team that covers the child/woman’s home address. The professional seeking the consultation for the child/woman retains a copy of this number in the child/woman’s personal record. 

A professional can make an appointment to attend the multi-agency FGM consultation meeting, to discuss an anonymised case by contacting the administrator at the Children & Families Assessment Team in the John Radcliffe Hospital. They should bring with them a completed and dated FGM screening tool which does not state the name of the subject.

Unborn or existing children subject to ‘no names’ consultations are not entered on Children’s Social Care electronic database (Framework) unless the concern about the child reaches the threshold for a Child in Need (s17 of the Children Act ‘89) or Child Protection Plan (s47 of the Children Act ’89) and is referred by name to Children’s Social Care (see Threshold of Needs Matrix).

At this point it is no longer a ‘no names’ consultation, and becomes a referral which leads to an assessment of the child and family.

If the risk assessment undertaken in the ‘no-names consultation’ indicates that the child may be at immediate risk of FGM, a referral will be made to the relevant Children and Families Assessment Team (Children’s Social Care). For an unborn baby where the family is not an open case to CSC, the Hospital Assessment Team will be the allocated team. For a child, this will be the C&F Assessment Team for the child’s home address.

On receipt of a referral of a child at immediate risk of FGM the procedures outlined in Section 7, Responding to FGM: Immediate Concern about a Child at Risk of FGM or that may have undergone FGM - Referral to Children, Education and Families should be followed.


11. Reducing the Prevalence of Female Genital Mutilation

Oxfordshire Safeguarding Children Board is committed to promoting awareness in the local area, particularly amongst local communities which practice FGM, that female genital mutilation is abusive to children and not legal in the UK.

See the Oxfordshire SCB Strategy to Prevent FGM 2014 for details of organisations able to advise on this form of community outreach work.

End