Ah, school summer holidays! Childhood memories of endless sunny days (it only ever rained if you were caravanning or camping!), being out from dawn to dusk without a care in the world. Back to school with any number of adventures to relate…

But for some girls, the summer holiday will only bring traumatic memories and enduring pain and discomfort. These girls will have been taken to a foreign land, and will have been mutilated against their will.

Female Genital Mutilation (FGM) (also known as sunna or female circumcision) is traditionally performed by a woman with no medical training using knives, scissors, scalpels, pieces of glass or razor blades. Anaesthetics are generally not used. Unsurprisingly, girls may have to be forcibly restrained [1].

Which girls are at risk?

The World Health Organization (WHO) [2] states that Female Genital Mutilation  (FGM) procedures are mostly carried out on young girls sometime between infancy and age 15 [3].  More than 125 million girls and women alive today have been cut in the 29 countries in the western, eastern, and north-eastern regions of Africa, the Middle East and Asia where FGM is concentrated, and among migrants from these areas [2,3].

In the UK, it has been estimated that over 20,000 girls under the age of 15 are at risk of female genital mutilation (FGM) each year, and that 66,000 women in the UK are living with the consequences of FGM. However, the true extent is unknown, due to the “hidden” nature of the crime. UK communities that are most at risk of FGM include Kenyan, Somali, Sudanese, Sierra Leonean, Egyptian, Nigerian and Eritrean. Non-African communities that practise FGM include Yemeni, Afghani, Kurdish, Indonesian and Pakistani.

FGM is deeply rooted within many cultures; while many believe that FGM is a form of abuse and violence and a clear violation of human rights, for those practising it, it is  an act of love or a rite of passage, or in the daughter’s best interest [4].

Legal position

In England, Wales and Northern Ireland, the practice is illegal under the Female Genital Mutilation Act 2003 (this offence captures mutilation of a female’s labia majora, labia minora or clitoris), and in Scotland it is illegal under the Prohibition of Female Genital Mutilation (Scotland) Act 2005 [5].

Under the 2003 Act it is an offence in England, Wales and Northern Ireland for anyone (regardless of their nationality and residence status) to:

• perform FGM in the UK
• assist the carrying out of FGM in the UK
• assist a girl to carry out FGM on herself in the UK
• assist from the UK a non-UK person to carry out FGM outside the UK on a UK national or permanent UK resident

FGM and healthcare practitioners

Although not in place as yet, under the Serious Crime Act 2015, healthcare professionals have a mandatory reporting requirement; they will have to notify the police if they discover that an act of FGM appears to have been carried out on a girl aged under 18 years.

Your organisation will have a policy in place, and the document Multi-Agency Practice Guidelines. Female Genital Mutilation is an excellent resource which includes good practice (including medical examination), guidance for health professionals, identifying at-risk children, and a list of external agencies and charities for professionals and the public [5]. Specialist clinics (NHS) offer a range of healthcare services for women and girls who have been subjected to FGM, including reversal surgery [6].

The school summer holidays are commonly known as the ‘cutting season’ because this is when most girls are taken abroad and cut – the extended break gives them a chance to heal before they return to school. Girls may well present with infections or bleeding.

The implications of FGM for UK practitioners were bought into sharp relief earlier this year when after the CPS brought a failed prosecution attempt against a doctor they accused of illegally stitching back up a young mother after she gave birth thereby re-doing the mutilation she suffered as a six-year-old in Somalia [7].

Incidents such as this clearly highlight the need for comprehensive organisational guidance, policy and procedures, aligned with staff awareness of the practice.

If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.

References

1. NHS Choices. Female Genital Mutilation. Available at:
   http://www.nhs.uk/Conditions/female-genital-mutilation/Pages/Introduction.aspx. Accessed July 2015
2. World Health Organization. Female Genial Mutilation. Fact sheet No.241. Available at: http://www.who.int/mediacentre/factsheets/fs241/en/ Accessed July 2015
3. UNICEF. Female Genital Mutilation/Cutting: a statistical overview and exploration of the dynamics of change. 2013. Available at:
   http://www.unicef.org/publications/index_69875.html. Accessed July 2015
4. Royal College of Nursing. Female genital mutilation. An RCN resource for nursing and midwifery practice (Second edition). 2014. Available at:
   http://www.rcn.org.uk/__data/assets/pdf_file/0010/608914/RCNguidance_FGM_WEB2.pdf. Accessed July 2015
5. HM Government. Multi-Agency Practice Guidelines. Female Genital Mutilation. 2014. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/380125/MultiAgencyPracticeGuidelinesNov14.pdf Accessed July 2015
6. Department of Health. NHS Specialist Services for Female Genital Mutilation. 2014. Available at:
   http://www.nhs.uk/NHSEngland/AboutNHSservices/sexual-health-services/Documents/List%20of%20FGM%20Clinics%20Mar%2014%20FINAL.pdf
7. The Telegraph (2015). NHS doctor cleared in less than 30 minutes in first FGM case. Available at: http://www.telegraph.co.uk/news/uknews/law-and-order/11390629/NHS-doctor-cleared-of-performing-FGM-amid-claims-he-was-used-as-a-scapegoat.html. Accessed July 2015